{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY A WORRELL","gend":1,"add":"3804 YATES ROAD","city":"SHAWSVILLE","state":"VA","zip":"24162-9998","dob":"1991-09-23","age":"","mstatus":"","insh":"2185609*01","cliId":"","pno":5402063480,"cno":5402063480,"email":"","ename":"","eno":"","pphy":"HEMPHILL, JULIA MD","ppno":5402681400,"pcpadd":"6920 ROANOKE RD,","pcpcity":"SHAWSVILLE","pcpstate":"VA","pcpzip":"24162-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Healthcare Corp","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402681300,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.011","F43.8","F33.1","F10.20","F15.20","F12.10","F32.9","F41.9","N30.00","F15.10","R30.0","F17.210","F41.8","R42.","F10.10","F11.23","F11.10","F17.200","Z20.822","V62.84","F33.2","F15.90","F11.90","F10.99","F43.10","Z20.828","S60.945A","M54.9","R52.","F10.929","R53.81","F10.239","F41.1","F10.24","F41.0","F11.20","R21.","F33.3","K08.89","K02.9","L02.01","S60.445A","W49.04XA","Z77.21","G40.909","R06.02","R53.83","Z21.","H53.8","NO DATA","B18.2","F31.81","F33.9","K21.9","G25.81","Z72.0","B88.8","Z56.0","Z87.891","R00.1","R94.31","F19.10","S02.2XXA","Z23.","R68.84","N30.90","R50.9","W46.1XXA","R55.","R07.9","Z01.419","E03.2","B00.9","M79.632","R05.","L02.413","B88.9","R19.7","R11.10","R20.0","R51.9","J06.9","J02.9","H60.502","V48.5XXA","L02.91","R20.2","S92.354A","M79.671","M25.571","R11.0","R07.1","R53.1","F19.239","F19.259","F10.19","F19.14","G47.9","Z91.19","F15.959","F29.","J45.30","R68.89","U07.1"],"date":["2021-01-27","2021-04-14","2021-04-14","2022-03-06","2022-03-06","2022-03-08","2021-10-30","2021-10-30","2022-03-01","2022-04-09","2022-06-30","2022-03-01","2022-06-30","2022-11-28","2022-03-08","2022-03-08","2022-04-09","2022-08-07","2022-04-09","2022-04-09","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-11-21","2021-03-24","2021-06-17","2022-01-14","2022-01-14","2022-01-14","2022-01-14","2022-03-06","2022-03-06","2022-03-06","2022-03-06","2023-01-11","2022-05-02","2022-08-04","2022-11-21","2022-09-17","2021-05-08","2021-06-17","2021-06-17","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-08-19","2022-11-21","2023-09-12","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-03-28","2022-03-28","2022-06-29","2022-06-29","2022-11-28","2021-03-05","2021-10-01","2021-10-01","2021-10-01","2022-01-14","2022-01-14","2022-02-19","2022-11-28","2022-06-29","2022-09-15","2022-09-15","2022-09-15","2021-08-12","2021-08-12","2021-09-04","2022-03-28","2022-06-29","2022-06-29","2022-08-19","2022-06-29","2022-10-06","2022-10-06","2022-10-06","2021-10-01","2022-08-19","2022-08-19","2022-11-17","2022-11-12","2022-11-12","2022-11-12","2022-11-28","2022-11-28","2022-03-07","2022-03-07","2022-03-08","2022-03-07","2022-03-07","2022-03-07","2022-03-08","2022-04-10","2023-09-05","2022-12-06","2023-09-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00555015902","CHLORDIAZEP","CAP 25MG","33","Select","Select",""],["","00378427577","VALACYCLOVIR","500 MG","6","Select","Select",""],["","65862037301","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","14","Select","Select",""],["","42806066305","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","59651036105","IBUPROFEN","600 MG","30","Select","Select",""],["","66993068130","OLANZAPINE","TAB 5MG","14","Select","Select",""],["","45802011222","MUPIROCIN","2 %","22","Select","Select",""],["","24385059029","MICONAZOLE 7","CRE 0.02","45","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","71093012105","GABAPENTIN","300 MG","60","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","70954001910","PRAZOSIN HCL","CAP 1MG","30","Select","Select",""],["","00135057602","FLONASE ALGY","SPR 50MCG","10","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","14","Select","Select",""],["","68382011614","RISPERIDONE","TAB 3MG","30","Select","Select",""],["","63824000850","MUCINEX","TAB 600MG ER","10","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","59762219807","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","11845005651","B-1","TAB 100MG","21","Select","Select",""],["","31722053305","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","50580040226","TYLENOL COLD","TAB SEVERE","40","Select","Select",""],["","10135062101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","69238209503","EMTR\/TENOFOV","TAB 200-300","28","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","28","Select","Select",""],["","51991001406","MELATONIN","TAB 3MG","60","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","54458032345","VITAMIN D","CAP 2000UNIT","30","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","1","Select","Select",""],["","13107003105","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","5","Select","Select",""],["","49884072703","DOXYCYC MONO","CAP 100MG","28","Select","Select",""],["","00781528464","CETIRIZINE","CHW 10MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","14","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","68382024705","BENZONATATE","100 MG","30","Select","Select",""],["","68382004110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","64380078508","PREDNISONE","TAB 20MG","6","Select","Select",""],["","55111068405","IBU","800 MG","30","Select","Select",""],["","65862017699","PENICILLN VK","TAB 500MG","30","Select","Select",""],["","60505036301","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","72888008000","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","00093506005","HYDROXYZ HCL","TAB 10MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE","40 MG","30","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","42571016201","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","64380079901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00093506005","HYDROXYZINE HCL","10 MG","90","Select","Select",""],["","65862001305","SERTRALINE HCL","100 MG","45","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","10135062101","PHENAZOPYRID TAB","200MG","6","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","15","Select","Select",""],["","69238209503","EMTR\/TENOFOV TAB","200-300","28","Select","Select",""],["","49702022813","TIVICAY TAB","50MG","28","Select","Select",""],["","54458032345","VITAMIN D CAP","2000UNIT","30","Select","Select",""],["","43598044774","NICOTINE TD DIS","14MG\/24H","14","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","60","Select","Select",""],["","13107003105","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","42806066305","BUSPIRONE TAB","10MG","60","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","30","Select","Select",""],["","00781729685","ALBUTEROL AER HFA","","7","Select","Select",""],["","51991001406","MELATONIN TAB","3MG","60","Select","Select",""],["","49884072703","DOXYCYC MONO CAP","100MG","28","Select","Select",""],["","68382011614","RISPERIDONE TAB","3MG","30","Select","Select",""],["","65862001305","SERTRALINE TAB","100MG","30","Select","Select",""],["","00781528464","CETIRIZINE CHW","10MG","30","Select","Select",""],["","64380078508","PREDNISONE TAB","20MG","6","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","5","Select","Select",""],["","45802091987","CETIRIZINE TAB","10MG","30","Select","Select",""],["","68382004110","PROMETHAZINE TAB","25MG","20","Select","Select",""],["","71093012105","GABAPENTIN CAP","300MG","60","Select","Select",""],["","31722053305","METHOCARBAM TAB","500MG","60","Select","Select",""],["","57237023305","SMZ-TMP DS TAB","800-160","14","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","15","Select","Select",""],["","69452014330","BENZONATATE CAP","100MG","30","Select","Select",""],["","55111068305","IBU TAB","600MG","30","Select","Select",""],["","65862017699","PENICILLN VK TAB","500MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","42571016201","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","61442010310","DICLOFENAC TAB","75MG DR","30","Select","Select",""],["","00093506005","HYDROXYZ HCL TAB","10MG","30","Select","Select",""],["","60505036301","OFLOXACIN DRO","0.3%OTIC","10","Select","Select",""],["","64380079901","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","00378427577","VALACYCLOVIR TAB","500MG","6","Select","Select",""],["","57237007530","ONDANSETRON TAB","4MG","10","Select","Select",""],["","72888008000","TRAMADOL HCL TAB","50MG","20","Select","Select",""],["","00904698640","MUCUS RELIEF ER","600 MG","30","Select","Select",""],["","00054074287","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","00185067405","HYDROXYZINE PAMOATE","25 MG","90","Select","Select",""],["","00378623205","CITALOPRAM HBR","20 MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}