{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE AVELENDA","gend":1,"add":"32 SHEN VALLEY DR","city":"WEYERS CAVE","state":"VA","zip":"24486-9998","dob":"1963-03-28","age":"","mstatus":"","insh":"2380052*01","cliId":"","pno":5042092852,"cno":5042092852,"email":"","ename":"","eno":"","pphy":"ALLEYNE, LISA ANTHONY MD","ppno":5402483413,"pcpadd":"1371 LEE HIGHWAY,","pcpcity":"VERONA","pcpstate":"VA","pcpzip":"24482-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine - Dayton","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402488413,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","E11.9","I10.","I35.8","E78.9","E55.9","M51.16","M51.17","I50.32","E11.22","I13.0","Z87.891","E03.9","E66.9","Z91.02","Z88.1","Z88.8","Z88.0","Z79.899","Z79.4","Z79.890","R42.","R07.89","R79.89","Z68.42","Z82.49","R11.0","Z79.84","M54.16","M54.17","J01.91","E66.01","Z20.822","J06.9","E11.69","E06.3","E87.5","M54.41","I35.0","I34.0","G89.29","E78.5","Z23.","Z12.39","J01.11","R50.9","M51.26","J34.89","R63.4","Z12.11","E10.9","I51.7","F32.9","K59.09","R07.9","M54.2","G47.10","Z11.59","Z80.0","B97.7","Z11.51","Z12.4","Z01.419","Z11.4"],"date":["2023-06-28","2023-06-28","2023-06-28","2023-06-28","2023-06-28","2021-10-13","2022-10-20","2022-10-20","2023-03-13","2022-12-12","2022-12-12","2022-12-12","2023-06-28","2023-06-14","2021-10-19","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-10-20","2022-04-29","2022-04-29","2022-04-29","2023-03-13","2022-04-29","2022-04-29","2022-12-12","2022-10-20","2021-10-19","2021-12-14","2023-03-13","2022-12-12","2022-09-14","2023-06-14","2023-06-14","2022-09-14","2023-03-13","2023-03-13","2023-03-13","2023-03-13","2021-12-02","2022-11-08","2023-06-26","2022-12-12","2022-12-12","2022-10-10","2021-12-14","2022-04-22","2023-06-14","2022-01-11","2022-05-04","2021-07-21","2021-07-21","2022-04-29","2022-04-29","2023-06-14","2023-06-14","2023-06-14","2023-06-26","2023-06-26","2023-06-26","2023-06-26","2023-06-26"],"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":[["","50228018010","GABAPENTIN","300 MG","30","Select","Select",""],["","72305020030","EUTHYROX","TAB 200MCG","90","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","180","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","90","Select","Select",""],["","69315013501","IMIPRAM HCL","TAB 50MG","90","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00603240632","BACLOFEN","10 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","60","Select","Select",""],["","68682010510","NIFEDIPINE","TAB 30MG ER","90","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","65862017260","TOPIRAMATE","50 MG","90","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","90","Select","Select",""],["","00527329043","LEVOTHYROXIN","TAB 200MCG","90","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00487950103","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","2","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","69315013501","IMIPRAMINE HCL","50 MG","90","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","18","Select","Select",""],["","31722070090","LOSARTAN POTASSIUM","25 MG","45","Select","Select",""],["","68645052254","SERTRALINE HCL","50 MG","30","Select","Select",""],["","16729045715","LEVOTHYROXINE SODIUM","200 MCG","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","53","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","68645058459","METFORMIN HCL","1000 MG","180","Select","Select",""],["","80777027398","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","00310621030","FARXIGA TAB","10MG","30","Select","Select",""],["","69315013501","IMIPRAM HCL TAB","50MG","90","Select","Select",""],["","31722070190","LOSARTAN POT TAB","50MG","90","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","00093505998","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","90","Select","Select",""],["","68682010510","NIFEDIPINE TAB","30MG ER","90","Select","Select",""],["","50228018010","GABAPENTIN CAP","300MG","30","Select","Select",""],["","68645058459","METFORMIN TAB","1000MG","60","Select","Select",""],["","00832105415","BACLOFEN TAB","10MG","30","Select","Select",""],["","00527329043","LEVOTHYROXIN TAB","200MCG","90","Select","Select",""],["","72305020030","EUTHYROX TAB","200MCG","90","Select","Select",""],["","65862017260","TOPIRAMATE TAB","50MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","60","Select","Select",""],["","00143924920","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","55111014512","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","00487950103","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","50111078751","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","14","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":""}]}]}