{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"K SEMAJGNAFESA","gend":0,"add":"              TS EGDIR 11                         ","city":"CASTLEWOOD               ","state":"VA","zip":"24224-9998","dob":"1951-12-18","age":"","mstatus":"","insh":"00110443","cliId":"","pno":"9667204960","cno":2766908618,"email":"","ename":"","eno":"","pphy":"OWENS, DIA P","ppno":2765977081,"pcpadd":"1721 LOVERS GAP RD,","pcpcity":"Vansant","pcpstate":"VA","pcpzip":246569781,"pcpcounty":"","pcpid":"","pcpname":"THOMPSON FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"11 RIDGE ST                                       ","madd2":"                                                  ","madd3":"","mcity":"CASTLEWOOD               ","mstate":"VA","mzip":"24224-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.10","M25.461","M25.561","R11.2","I10","G89.29","E11.9","Z79.4","Z79.899","Z72.0","E11.40","M54.16","Z00.8","F17.200","Z13.9","Z13.89","Z79.891","E11.42","E11.22","E11.3299","E78.2","E11.65","N18.31","M54.40","G89.4","M79.621","R07.89","M96.1","M51.37","M54.42","M54.5","M79.605","F17.210","D12.3","D12.4","D12.7","R19.5","K63.5","Z51.81","F11.20","Z12.5","M25.50","W19.XXXA","M79.89","Z01.818","M17.11","G89.18","M17.31","M23.41","M17.9","Z12.11","B19.20","M47.816","E11.00","R10.11","K80.20","I25.10","I35.0","I65.29","M54.9","Z28.21","N17.9","E66.9","I44.4","R00.1","I42.8","R93.1","I51.89","I08.0","R94.31","R76.8","N40.0","K42.9","R07.9","J43.2","J98.11","J98.4","Z23","Z13.31","M48.061","Z11.4","Z11.59","R80.9","H43.89","M25.569","Z47.1","Z96.651","R26.89","M62.81","N18.3","R80.1","R53.1","M25.559","E11.21","E11.51","I12.9","E87.5","M20.41","Z01.89","E11.3293","H04.121","H04.122","H02.413","H04.123","G06.2","M43.10","M79.604","I73.9","E78.5","E87.2","G62.9","N18.9","E29.1","R53.82","E11.649","D64.9","M76.02","R16.1","B18.2","N18.30","M23.91","L03.115","M79.609","M79.661","Z96.659","R22.41","N19","M79.10","Z71.3","Z71.82","Z68.35","E11.319","M19.90","E78.00","F32.A","Z86.010","I96","I95.9","E11.69","E11.52","E87.20","M86.9","E11.621","Z68.30","E86.0","L97.519","L08.9","X58.XXXA","S90.424A","R00.0","R60.9","L53.9","Z79.82","I45.9","I51.7","I25.2","R01.1","R09.89","R10.13","R05.8","I77.9","I70.223","E11.59","R11.10","R10.9","R19.7","R77.8","Z20.822","M86.171","M86.471","E13.51"," ","R07.2","L97.514","I70.211","I65.23","I25.9","R94.39","I70.201","I65.22","L03.119","L97.509","D64.89","S91.301A","I70.219","E11.628","D63.8","I70.245","I70.235","L97.529","I70.213","N20.0"],"date":["2019-02-15","2019-04-02","2019-04-02","2022-10-14","2022-12-02","2022-11-09","2022-11-17","2022-11-30","2022-09-06","2019-09-04","2022-01-20","2021-04-07","2021-07-22","2022-11-22","2021-07-22","2021-07-22","2019-07-23","2022-11-30","2022-11-30","2022-10-17","2022-11-22","2022-10-17","2022-11-30","2019-09-09","2022-07-27","2019-08-19","2022-10-17","2020-05-06","2019-08-27","2019-09-06","2021-07-22","2019-09-06","2022-11-22","2018-09-10","2018-09-10","2018-09-10","2018-09-10","2022-07-27","2020-11-11","2022-11-09","2022-09-06","2021-04-07","2019-02-13","2022-09-28","2019-03-27","2022-11-22","2019-04-09","2019-04-09","2019-04-09","2019-05-10","2022-07-27","2022-10-17","2018-08-29","2022-09-06","2019-08-15","2019-08-15","2022-11-09","2022-12-02","2022-11-10","2019-08-14","2019-08-14","2022-10-20","2022-11-22","2019-08-14","2019-08-14","2019-08-15","2019-08-15","2022-11-21","2022-10-04","2022-10-18","2020-10-05","2019-08-14","2019-08-14","2022-11-21","2019-08-14","2019-08-14","2019-08-14","2020-09-24","2018-11-27","2020-05-06","2020-06-26","2020-06-26","2021-04-07","2019-06-05","2019-03-18","2019-05-10","2019-05-10","2019-05-10","2019-05-10","2020-06-25","2020-06-25","2019-09-04","2019-09-04","2022-11-10","2022-11-22","2022-11-30","2020-09-28","2020-10-07","2020-02-12","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2020-05-05","2020-05-06","2020-05-06","2022-11-09","2022-11-22","2022-11-09","2020-05-12","2020-05-12","2022-10-19","2020-09-24","2022-09-06","2019-04-10","2019-04-10","2019-04-18","2020-10-05","2022-07-27","2022-11-10","2019-01-27","2022-11-09","2019-05-09","2022-11-09","2019-05-09","2019-05-09","2019-08-14","2018-10-03","2021-07-22","2021-07-22","2021-07-22","2022-07-27","2022-07-27","2022-11-22","2022-10-17","2022-07-27","2022-11-09","2022-10-20","2022-11-09","2022-11-09","2022-10-17","2022-12-06","2022-12-06","2022-10-17","2022-10-17","2022-11-22","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-10-18","2022-10-18","2022-10-18","2022-10-04","2022-10-04","2022-10-14","2022-10-14","2022-10-25","2022-10-18","2022-10-18","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-11-09","2022-10-19","2022-11-01","2022-12-06","2022-11-21","2022-12-06","2022-12-02","2022-12-02","2022-11-21","2022-11-21","2022-11-22","2022-11-22","2022-11-10","2022-11-11","2022-11-10","2022-12-06","2022-12-06","2022-11-09","2022-11-09","2022-11-22","2022-11-22","2022-11-22","2022-11-10","2022-11-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","31722070210","LOSARTAN","TAB 100MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","00093077198","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","16729021101","DOXAZOSIN","TAB 1MG","90","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","21.00","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","56151146304","TRUE","TES GLUCOSE","50","Select","Select",""],["","08470385001","UNIFINE","MIS 31GX5MM","100","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","08222095435","ULTIGUARD","MIS 32GX4MM","100","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","28","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4,000.00","Select","Select",""],["","55111019605","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","23155065205","METRONIDAZOL","TAB 500MG","90","Select","Select",""],["","47781022905","OXYCOD\/APAP","TAB 7.5-325","90","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00071101468","LYRICA","CAP 75MG","60","Select","Select",""],["","00054001729","PREDNISONE","TAB 10MG","21","Select","Select",""],["","70461001903","FLUAD","INJ 2019-20","0.5","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","08496310101","EASY","MIS 31GX3\/16","100","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}