{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA G DEMATTIES","gend":1,"add":"PO BOX 496","city":"FLOYD","state":"VA","zip":"24091-9998","dob":"1983-10-28","age":"","mstatus":"","insh":"2465586*01","cliId":"","pno":8289941582,"cno":8289941582,"email":"","ename":"","eno":"","pphy":"PROVINCE, RANDY DO","ppno":5409216000,"pcpadd":"159 HARTLEY WAY,","pcpcity":"PEARISBURG","pcpstate":"VA","pcpzip":"24134-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Giles Community Hospital","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409215606,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.50","R73.9","Z82.69","Z82.61","Z83.49","F10.21","F17.200","F31.81","E06.3","Z79.899","G60.9","Z76.89","NO DATA","M21.70","J01.80","F41.9","F43.10","J02.9","R05.8","U07.1","J01.90","N93.9","E55.9","J45.21","Z20.828","J01.01","H65.111","K21.9","D72.829","Z91.09","B02.8","Z3A.09","E03.9","D22.4","L20.89","O99.280","J45.20","O26.893","R03.0","Z3A.32","Z85.41","O09.523","Z3A.33","O14.04","Z3A.37","Z37.0","O13.3","R60.0","Z29.14","O14.93","Z3A.00","O14.00","O09.43","Z3A.34","O9A.213","S61.251A","O99.283","Z3A.36","O99.333","F17.210","Z79.82","R51.9","O10.913","Z23.","O14.03","F31.9","G43.909","O99.353","Z87.59","O99.343","O26.23","O80."],"date":["2022-05-18","2022-08-16","2022-05-18","2022-05-18","2022-05-18","2022-03-28","2022-12-05","2022-08-16","2023-04-14","2022-03-28","2022-03-28","2022-03-28","2022-07-11","2022-07-11","2022-09-19","2022-08-16","2022-05-04","2022-08-23","2022-08-23","2022-08-23","2022-12-12","2022-09-07","2023-05-12","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-05-18","2022-05-18","2022-05-18","2023-03-06","2023-03-06","2023-09-11","2023-03-29","2023-03-29","2023-05-12","2023-07-27","2023-08-15","2023-08-15","2023-08-15","2023-08-18","2023-09-11","2023-08-21","2023-09-15","2023-09-15","2023-09-15","2023-08-15","2023-08-15","2023-08-15","2023-09-11","2023-08-17","2023-08-18","2023-08-28","2023-08-28","2023-08-12","2023-08-12","2023-09-11","2023-09-11","2023-08-17","2023-08-17","2023-08-18","2023-08-17","2023-08-15","2023-08-15","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18"],"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":[["","00378427677","VALACYCLOVIR","1000 MG","21","Select","Select",""],["","64380078508","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00456045701","ARMOUR THYRO","TAB 15MG","30","Select","Select",""],["","42192033001","NP THYROID","60 MG","30","Select","Select",""],["","23155002305","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","67877057130","ESOMEPRA MAG","CAP 20MG DR","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","60","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00781729685","ALBUTEROL","AER HFA","7","Select","Select",""],["","45802084778","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","00456074613","AERCHMBR PLS","MIS LRG MASK","1","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00186037220","SYMBICORT","80-4.5 MCG","10.2","Select","Select",""],["","16729045217","LEVOTHYROXINE SODIUM","112 MCG","30","Select","Select",""],["","00904672040","ACETAMINOPHEN","500 MG","100","Select","Select",""],["","43598050990","ESOMEPRAZOLE MAGNESIUM","20 MG","30","Select","Select",""],["","55566650003","ENDOMETRIN","100 MG","21","Select","Select",""],["","33342032980","TRIAMCINOLONE ACETONIDE","0.1 %","80","Select","Select",""],["","16103037611","PHARBETOL","500 MG","100","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","00527169501","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","10","Select","Select",""],["","00781729685","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","64380073706","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","57237004330","VALACYCLOVIR TAB","1GM","21","Select","Select",""],["","64380078508","PREDNISONE TAB","20MG","10","Select","Select",""],["","00456045701","ARMOUR THYRO TAB","15MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM TAB","10MG","60","Select","Select",""],["","42192033101","NP THYROID TAB","90MG","30","Select","Select",""],["","67877057190","ESOMEPRA MAG CAP","20MG DR","90","Select","Select",""],["","23155002305","BUSPIRONE TAB","5MG","90","Select","Select",""],["","61442010305","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","27808023302","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","00310737220","BUDES\/FORMOT AER","80-4.5","10","Select","Select",""],["","00456074613","AERCHMBR PLS MIS LRG MASK","","1","Select","Select",""],["","00186037220","SYMBICORT AER","80-4.5","10","Select","Select",""],["","45802084778","FEXOFENADINE TAB","180MG","30","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","00781729685","ALBUTEROL AER HFA","","7","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","53746052101","PROMETHAZINE HCL","25 MG","10","Select","Select",""],["","76204020030","ALBUTEROL SULFATE","2.5 MG\/3ML","90","Select","Select",""],["","00456046001","ARMOUR THYROID","90 MG","30","Select","Select",""],["","49884012201","LABETALOL HCL","100 MG","60","Select","Select",""],["","45802048678","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","49483060350","IBUPROFEN","600 MG","60","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":""}]}]}