{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R YNNADSIRROM ","gend":0,"add":"      TEERTS SELPATS 0051                         ","city":"RADFORD                  ","state":"VA","zip":"24141-9998","dob":"1954-01-29","age":"","mstatus":"","insh":"00111379","cliId":"","pno":"3804502635","cno":"","email":"","ename":"","eno":"","pphy":"GUERRA, PETE ALEXIS","ppno":5403810820,"pcpadd":"215 ROANOKE ST,","pcpcity":"Christiansburg","pcpstate":"VA","pcpzip":240733025,"pcpcounty":"","pcpid":"","pcpname":"FREE CLINIC OF THE NEW RIVER VALLEY","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"LOT 45                                            ","add3":"","madd1":"1500 STAPLES STREET                               ","madd2":"LOT 45                                            ","madd3":"","mcity":"RADFORD                  ","mstate":"VA","mzip":"24141-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","G47.09","F06.8","G31.84","M25.512","M25.612","M54.12","M75.102","A41.9","R06.02","G93.41","N17.9","E11.65","E78.5","E86.0","F17.200","J44.9","Z79.02","Z79.4","Z86.73","Z88.0","F33.3","F43.10","F41.1","G47.00","R41.3","I10","R51","I65.23","E11.9","F01.50","M54.42","M54.41","G89.29","B34.9","R05","R11.0","R19.7","E11.36","E11.39","H26.9","H40.9","H42","I11.0","I50.9","Z21","F17.210","F17.290","Z87.891","M75.02","M75.22","M75.122","M19.012","M62.81","M54.89","R09.02","W19.XXXA","E11.40","L03.031","B35.1","M79.674","S46.912A","X58.XXXA","E87.2","E13.9","E11.00","R53.1","W18.39XA","M54.5","N18.9","F33.2","J45.909","M54.40","R29.6","Z79.84","B20","J01.40","R07.89","R06.89","F33.9","F31.30","G47.9","F03.90","S46.012A","M75.82","M54.2","K65.1","R41.82","Z86.79","R00.0","K35.32","K37","I69.398","B19.20","Z90.49","K35.80","R10.9","R11.2","D72.829","R93.3","R93.5","E87.6","E83.39","R03.0","R10.31","R33.9","Z20.822","K35.30","E11.10","K63.0","T81.41XA","N40.1","Z79.51","R33.8","E03.9"," "],"date":["2022-07-05","2021-08-13","2021-08-13","2021-08-13","2020-09-12","2020-09-11","2020-09-16","2020-09-11","2022-07-05","2022-07-04","2022-07-05","2020-01-14","2022-07-05","2021-05-09","2020-01-14","2020-03-26","2022-07-04","2020-01-14","2020-03-26","2022-07-01","2020-08-24","2020-04-10","2020-04-10","2020-04-10","2020-08-04","2020-08-04","2022-07-01","2020-08-04","2020-02-10","2022-07-01","2020-02-11","2020-03-26","2020-03-26","2020-03-26","2021-05-09","2021-05-09","2021-05-09","2021-05-09","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2022-07-01","2022-07-01","2020-08-24","2022-07-04","2021-05-09","2020-09-01","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2020-04-17","2020-04-17","2020-04-17","2020-04-17","2020-08-24","2020-08-24","2022-07-05","2020-04-30","2020-01-15","2020-03-24","2020-03-24","2020-03-26","2020-05-29","2020-05-29","2020-05-29","2020-04-30","2020-03-24","2022-07-05","2022-07-01","2020-01-10","2020-01-14","2020-01-14","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-09-12","2020-09-16","2020-09-16","2022-07-05","2022-07-04","2022-07-04","2022-07-04","2022-07-06","2022-07-06","2022-07-05","2022-07-05","2022-07-05","2022-07-01","2022-07-04","2022-07-04","2022-07-04","2022-07-04","2022-07-04","2022-07-04","2022-07-04","2022-07-04","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-06"],"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":[["","67877024760","QUETIAPINE","TAB 300MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10.2","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","90","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","71093011205","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","59267030402","PFIZER","INJ BA4\/BA5","0.3","Select","Select",""],["","70461012003","FLUAD","INJ 0.5ML","0.5","Select","Select",""],["","68382080610","TRAZODONE","TAB 100MG","30","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","30","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","00115180402","HYDROXYZ","CAP 50MG","180","Select","Select",""],["","33342015611","CELECOXIB","CAP 100MG","60","Select","Select",""],["","16571066450","METRONIDAZOL","TAB 500MG","6","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","2","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","10","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","9","Select","Select",""],["","13107000305","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","5","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","7","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}