{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA D DUNN","gend":1,"add":"2772 FERNLAWN RD APT 408","city":"SALEM","state":"VA","zip":"24153-9998","dob":"1990-12-27","age":"","mstatus":"","insh":"2242652*01","cliId":"","pno":5405893141,"cno":5405893141,"email":"","ename":"","eno":"","pphy":"SAUNDERS, CARL NP","ppno":5403620360,"pcpadd":"3716 MELROSE AVE NW,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24017-9998","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":5403625590,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z51.81","Z79.899","F17.210","O99.325","B19.20","F11.21","F33.1","B17.10","Z71.51","R76.8","F17.200","F90.9","F41.1","F31.60","F60.3","F43.10","H57.12","N89.8","N30.01","F15.10","F11.90","Z86.19","F11.99","F19.90","L73.8","L30.9","R10.2","R03.0","F41.9","F41.0","Z30.015","Z30.09","F32.1","Z01.419","Z11.3","Z12.4","G47.00","O99.320","Z3A.00","R56.9","G43.009","Z72.89","N92.1","Z71.89","A08.4","F32.0","J06.9","Z20.822","F11.288"],"date":["2023-09-12","2022-08-04","2023-09-12","2023-02-02","2021-04-15","2021-06-24","2022-06-22","2023-09-15","2021-11-05","2022-07-18","2021-11-17","2023-03-15","2023-09-15","2022-03-25","2022-06-22","2022-03-25","2022-03-25","2021-04-14","2022-04-20","2022-04-20","2021-01-07","2021-10-13","2021-12-01","2022-10-13","2022-09-26","2021-03-03","2021-03-03","2022-09-26","2022-09-26","2021-05-06","2021-05-06","2021-06-10","2022-05-11","2022-01-19","2021-11-05","2021-11-05","2021-11-05","2022-05-11","2021-11-03","2021-11-03","2021-03-10","2021-03-10","2021-08-26","2021-09-15","2021-09-15","2021-11-10","2022-09-26","2021-09-08","2021-09-08","2023-09-12"],"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":[["","63824000836","MUCINEX","TAB 600MG ER","30","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","60","Select","Select",""],["","31722053960","LEVETIRACETA","TAB 1000MG","180","Select","Select",""],["","69238207907","PROPRANOLOL","TAB 40MG","90","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","56","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","135","Select","Select",""],["","55111029198","SUMATRIPTAN","TAB 25MG","9","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","68462030329","HEATHER","TAB 0.35MG","28","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","70710114003","FLUCONAZOLE","200 MG","21","Select","Select",""],["","66993060536","ETONOGESTREL","MIS ETHY EST","3","Select","Select",""],["","54092039101","ADDERALL XR","30 MG","30","Select","Select",""],["","68180088673","NIKKI","TAB 3-0.02MG","28","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","10","Select","Select",""],["","43598044828","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","00527551537","AMPHET\/DEXTR","CAP 30MG ER","14","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","60","Select","Select",""],["","57844011001","ADDERALL","TAB 10MG","14","Select","Select",""],["","00781717612","NALOXONE HCL","4 MG","2","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","42571025101","CLINDAMYCIN","CAP 150MG","56","Select","Select",""],["","45802000125","NICOTINE GUM","4 MG","110","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","60","Select","Select",""],["","00781237101","DEXTROAMPHETAMINE-AMPHET ER","30 MG","30","Select","Select",""],["","65162046935","ELURYNG .","12-.015MG","3","Select","Select",""],["","00555097402","DEXTROAMPHETAMINE-AMPHETAMINE","30 MG","30","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","180","Select","Select",""],["","65862049301","QUETIAPINE FUMARATE","200 MG","135","Select","Select",""],["","54092039101","ADDERALL XR CAP","30MG","14","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","48","Select","Select",""],["","68180044801","QUETIAPINE TAB","200MG","30","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","48","Select","Select",""],["","55111029298","SUMATRIPTAN TAB","50MG","9","Select","Select",""],["","57844013001","ADDERALL TAB","30MG","30","Select","Select",""],["","00555097402","AMPHET\/DEXTR TAB","30MG","30","Select","Select",""],["","00527551537","AMPHET\/DEXTR CAP","30MG ER","30","Select","Select",""],["","68462010430","FLUCONAZOLE TAB","200MG","3","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","66993060536","ETONOGESTREL MIS ETHY EST","","3","Select","Select",""],["","00185012201","NITROFURANTN CAP","100MG","14","Select","Select",""],["","69097083502","SERTRALINE TAB","100MG","30","Select","Select",""],["","69238207907","PROPRANOLOL TAB","40MG","90","Select","Select",""],["","42571025101","CLINDAMYCIN CAP","150MG","56","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":""}]}]}