{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMUEL BURWELL","gend":0,"add":"1510 WILLIAMSON ROAD NE 3RD FLOOR","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1967-02-14","age":"","mstatus":"","insh":"2281917*01","cliId":"","pno":5409704748,"cno":5409704748,"email":"","ename":"","eno":"","pphy":"KIDD, JOSEPH H DO","ppno":5404279200,"pcpadd":"2145 MT PLEASANT BLVD,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24014-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5404273237,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L02.91","L03.818","E11.65","R94.31","I10.","M79.89","I25.10","N17.9","E11.59","I50.22","N30.00","I11.0","E78.2","D50.9","B96.89","E83.52","E87.5","I25.2","I25.5","I95.2","T46.4X5A","R19.7","Z87.891","K61.1","M72.6","A41.9","R65.21","L98.9","N49.3","L02.215","L02.31","E83.39","Z20.822","N49.2","L02.416","F17.210","Z79.02","Z79.82","Z79.84","Z01.810","Z95.5","R82.90","D64.9","R03.0","E11.29","R80.9","Z78.9","Z92.89","L08.89","I96.","D72.829","E11.9","Z12.11","Z12.12","V58.89","R53.83","I95.9","R06.02","R11.2","R63.4","Z80.42","Z12.5","Z80.0","F17.200","T81.31XA","I48.0","R63.8","N39.0","G47.00","E78.5","I50.20","Z79.4","E11.52","A48.0","R57.8","A40.8","A41.4","Z16.11","Z59.9","Z72.0","R00.0","Z79.899","Z79.01"],"date":["2022-02-15","2022-02-15","2022-02-15","2022-08-09","2023-02-15","2022-02-24","2022-08-10","2022-10-12","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-10","2022-08-09","2022-08-10","2022-08-15","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2023-02-01","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-04-06","2023-02-01","2023-02-15","2022-02-15","2022-02-15","2022-02-15","2022-11-06","2022-07-14","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-08-08","2022-10-12","2022-08-29","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-02-17","2022-02-17","2022-02-17","2022-08-10","2022-03-16","2022-03-16","2022-05-18","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-15","2022-08-15","2022-08-15","2022-04-06","2022-03-24","2022-06-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-03-28","2022-03-28","2022-08-10","2021-04-08","2021-12-10"],"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":[["","45963070996","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","69618006610","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","60505025303","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","65862001005","METFORMIN","TAB 1000MG","60","Select","Select",""],["","68180051202","LISINOPRIL","2.5 MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","28","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","45","Select","Select",""],["","00536124710","SENEXON-S","TAB 8.6-50MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00781223410","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","43547040550","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","60505267109","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","51383000314","VASHE WOUND","SOL THERAPY","475","Select","Select",""],["","00338004804","SODIUM CHLOR","SOL 0.9% IRR","1000","Select","Select",""],["","00597015330","JARDIANCE","25 MG","30","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","60505267109","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","45963070996","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","11917007114","GAUZE DRESSING","4\" X 4\"","100","Select","Select",""],["","69618006610","ASPIRIN EC","81 MG","30","Select","Select",""],["","42858000101","OXYCODONE HCL","5 MG","10","Select","Select",""],["","00093227434","AMOXICILLIN-CLAVULANATE POTASS","500-125 MG","14","Select","Select",""],["","45963070996","METOPROL SUC TAB","25MG ER","90","Select","Select",""],["","69618006610","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","60505025303","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","65862001005","METFORMIN TAB","1000MG","60","Select","Select",""],["","68180051202","LISINOPRIL TAB","2.5MG","30","Select","Select",""],["","53746051105","SPIRONOLACT TAB","25MG","45","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","20","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","28","Select","Select",""],["","43547040550","METHOCARBAM TAB","500MG","30","Select","Select",""],["","00536124710","SENEXON-S TAB","8.6-50MG","30","Select","Select",""],["","60505267109","ATORVASTATIN TAB","80MG","90","Select","Select",""],["","00338004804","SODIUM CHLOR SOL","0.9% IRR","1000","Select","Select",""],["","00597015330","JARDIANCE TAB","25MG","30","Select","Select",""],["","00781223410","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","51383000314","VASHE WOUND SOL THERAPY","","475","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","00143980305","DOXYCYCL HYC CAP","100MG","20","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":""}]}]}