{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL WYANT","gend":1,"add":"1122 WESTVIEW SCHOOL ROAD","city":"WEYERS CAVE","state":"VA","zip":"24486-9998","dob":"1981-01-18","age":"","mstatus":"","insh":"7881428*01","cliId":"","pno":5408104939,"cno":5408104939,"email":"","ename":"","eno":"","pphy":"RICE, GILBERT C DO","ppno":5402349241,"pcpadd":"1151 KEEZLETOWN RD SUITE 101,","pcpcity":"WEYERS CAVE","pcpstate":"VA","pcpzip":"24486-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine - Weyers Cave","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402349200,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.1","R11.2","R10.9","R10.10","R19.7","F10.230","K29.00","K90.0","K70.9","Z72.0","F19.10","R50.9","R42.","A08.4","Q43.3","D72.819","F15.21","E87.6","F17.210","F12.90","J10.1","Z86.73","Z79.899","K64.8","R10.13","K21.9","R10.11","R14.0","R10.84","Z83.71","F10.20","F12.10","N76.4","L53.9","K82.8","K52.9","E78.00","R11.0","I10.","R11.10","N17.9","Z20.822","Z13.9","R10.30","R10.33","K57.30","K44.9","K63.89","D72.820","K29.50","K31.89","Z12.11","K29.70","Q43.8","Z67.10","E78.5","F15.20","K29.20","NO DATA","K76.0","F10.10","K57.90","F10.239","N39.0","R93.3","R79.89","K29.60","R69.","F10.129","K76.4","J30.89","J02.9","G89.29","R10.12","R03.0","R73.9","F41.9","K92.0","R74.01","K22.6","R11.15","I15.9","N30.01","R17."],"date":["2023-04-17","2023-08-17","2023-08-17","2022-09-28","2023-04-18","2023-04-17","2022-09-28","2022-10-18","2022-10-18","2023-08-16","2022-10-18","2022-12-30","2022-12-30","2023-01-02","2023-01-02","2023-01-02","2023-01-02","2023-08-15","2023-07-05","2023-08-17","2023-01-03","2023-01-02","2023-01-02","2023-01-20","2023-04-20","2023-01-09","2023-04-18","2021-11-22","2023-08-17","2022-02-07","2022-02-07","2022-10-17","2022-02-19","2022-02-19","2023-01-09","2023-04-20","2022-02-23","2023-01-02","2023-04-17","2023-07-05","2022-08-28","2022-02-03","2022-02-03","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-10-17","2023-08-16","2023-08-17","2023-08-17","2022-10-17","2021-06-18","2021-06-19","2021-06-19","2023-08-03","2023-01-09","2021-05-03","2021-05-03","2022-02-19","2022-09-09","2023-04-17","2023-04-18","2023-04-18","2023-07-05","2023-07-05","2023-08-03","2023-08-17","2023-08-17","2023-08-17","2023-08-16","2023-08-16","2023-08-15","2023-08-15"],"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":[["","65862085901","FAMOTIDINE","20 MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","16714087503","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","16714065102","CIPROFLOXACN","TAB 250MG","10","Select","Select",""],["","65649040001","PLENVU","SOL ","3","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","28","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59762040101","SUCRALFATE","1 G","90","Select","Select",""],["","11534016503","FOLIC ACID","1 MG","30","Select","Select",""],["","31604001796","MULTI 50+","TAB FOR HER","30","Select","Select",""],["","57896050101","ONE-DAILY","TAB MULT-VIT","30","Select","Select",""],["","11845005651","B-1","TAB 100MG","30","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00031875618","ROBITUSSIN","LIQ 20-400MG","237","Select","Select",""],["","53746052101","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","69315031228","PROCTO-MED HC","2.5 %","28","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","00093220301","METOCLOPRAMIDE HCL","10 MG","20","Select","Select",""],["","68462039610","OMEPRAZOLE","20 MG","30","Select","Select",""],["","62037072001","POTASSIUM CHLORIDE","20 MEQ","10","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","65649040001","PLENVU SOL","","3","Select","Select",""],["","10572010001","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","72606050902","FAMOTIDINE TAB","20MG","90","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","11534016503","FOLIC ACID TAB","1MG","30","Select","Select",""],["","57896050101","ONE-DAILY TAB MULT-VIT","","30","Select","Select",""],["","11845005651","B-","1 TAB 100MG","30","Select","Select",""],["","00093221001","SUCRALFATE TAB","1GM","120","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","31604001796","MULTI","50+ TAB FOR HER","30","Select","Select",""],["","53746052101","PROMETHAZINE TAB","25MG","12","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","30","Select","Select",""],["","00031875618","ROBITUSSIN LIQ","20-400MG","237","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","60","Select","Select",""],["","65862001205","SERTRALINE HCL","50 MG","30","Select","Select",""],["","00536589571","NICOTINE PATCH","14MG\/24HR","28","Select","Select",""],["","29300041901","AMITRIPTYLINE HCL","10 MG","30","Select","Select",""],["","31604001796","ESSENTIAL WOMAN","50+ 0.4MG-250","30","Select","Select",""],["","31604001281","VITAMIN B-","1 100 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":""}]}]}