{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NYLORACSIRRAH A","gend":1,"add":"        TEERTS HT4 N 5033                         ","city":"WYTHEVILLE               ","state":"VA","zip":"24382-4613","dob":"1957-03-21","age":"","mstatus":"","insh":"00112676","cliId":"","pno":"1667295963","cno":2766207534,"email":"","ename":"","eno":"","pphy":"DUMS, ROBERT M","ppno":5407191815,"pcpadd":"35 MEDICAL CT,","pcpcity":"Hardy","pcpstate":"VA","pcpzip":241013992,"pcpcounty":"","pcpid":"","pcpname":"CARILION URGENT CARE WESTLAKE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"3305 N 4TH STREET                                 ","madd2":"                                                  ","madd3":"","mcity":"WYTHEVILLE               ","mstate":"VA","mzip":"24382-4613","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M20.41","M20.31","M79.7","E78.2","M81.0","Z86.39","R73.9","H60.502","Z13.31","F33.2","F02.81","Z01.84","H69.82","T16.2XXD","Z98.890","F51.01","Z29.9","Z00.00","R76.8","J01.10","R50.9","M85.89","C50.112","C50.912","J45.909","E78.5","C80.1","E11.9","F32.9","Z12.11","Z01.419","Z11.51","N95.2","Z85.3","N39.46","K29.50","M81.8","Z47.89","M79.671","H61.22","Z17.0","Z12.4","Z79.899","N39.0","Z08","Z79.811","Z92.3","R94.31","K21.00","F33.9","L71.8","L57.0","R76.0","Z23","G89.4","M54.5","M54.16","N64.89","R11.2","R10.11","Z20.822","Z01.818","Z12.31","R07.9","R06.02","R01.1","K21.9","R11.0","R10.13","I25.10","M19.071","E11.42","E11.36","H26.9","J44.9","F41.9","Z68.32","Z85.828","Z78.0","R35.0","M19.079","C50.919","J30.1","G43.909","M15.9","Z98.41","Z98.42","Z68.24","M51.36","M54.50","K29.60","G89.29","M62.81","M25.551","R29.3","K57.30","K52.9","R93.3","K29.70","L30.9","R30.9","J32.9","I34.0","I51.89","F50.89","E66.9","F43.21","L82.0","L53.8","M84.374A","Z48.89","D48.5","J06.9","J02.9","B97.89","R21","M25.579","R73.09","Z91.018","M50.20","R32","M51.26","M51.27","M50.10","R39.81","R20.0","R10.821","R52","R14.0","Z71.3","Z71.82","B35.1","M79.675","M79.674","L60.3","R63.5","R68.89","Z71.89","L81.4","M48.061","M48.07","L82.1","L29.8","D18.01","R74.8","R10.2","Z01.411","N60.19","R60.9","M54.9","E11.40","E78.00","K29.00","G47.9","Z68.28"," ","K57.32","R10.32","E78.1","Z90.12","R10.30","Z79.51","R10.9","L60.0","T85.848A","R10.84","R73.03","L03.031","L03.032","S90.111A","I78.8","T84.84XA"],"date":["2022-03-31","2022-03-31","2022-10-17","2022-07-19","2022-09-15","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2021-01-08","2021-01-08","2020-07-23","2020-02-14","2020-02-14","2021-07-07","2022-10-17","2019-10-03","2022-03-18","2022-10-17","2021-11-01","2021-11-09","2021-12-14","2022-12-09","2022-09-15","2022-10-17","2022-10-17","2021-04-07","2022-09-19","2021-04-07","2021-04-07","2022-01-07","2022-01-07","2022-06-06","2022-04-14","2022-01-07","2021-09-24","2022-06-06","2022-05-24","2022-12-01","2020-03-05","2022-06-06","2022-01-07","2022-09-12","2019-05-16","2020-08-27","2022-09-15","2020-08-27","2022-07-19","2022-07-15","2022-07-15","2021-12-23","2022-10-21","2020-12-10","2022-01-10","2020-12-10","2021-09-14","2021-09-14","2019-12-30","2021-08-02","2021-08-02","2022-03-25","2022-03-25","2022-01-07","2022-06-22","2022-05-11","2022-05-11","2022-09-15","2022-09-15","2021-09-08","2022-06-22","2022-03-31","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-09-15","2021-12-14","2021-08-17","2022-03-25","2021-07-27","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2021-08-18","2021-10-13","2021-08-24","2021-08-24","2020-01-07","2020-01-07","2020-01-07","2021-07-27","2022-09-12","2021-07-27","2021-08-24","2021-01-14","2019-04-29","2020-05-21","2022-06-22","2022-06-22","2022-03-18","2022-03-18","2022-03-18","2022-01-18","2022-01-18","2022-07-05","2022-07-05","2021-12-23","2020-03-26","2020-03-26","2020-03-26","2020-09-04","2020-09-04","2022-03-18","2022-01-10","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-05-13","2021-05-12","2021-06-01","2021-07-02","2021-05-12","2022-09-19","2022-09-19","2022-11-16","2022-09-19","2022-10-17","2020-09-09","2021-07-02","2022-10-21","2019-11-20","2019-11-20","2020-09-15","2021-04-22","2022-03-15","2021-07-27","2021-07-27","2021-01-04","2021-01-04","2020-04-23","2021-07-13","2022-09-15","2022-09-15","2021-08-24","2022-07-19","2020-09-28","2022-12-09","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-12","2022-09-12","2022-09-12","2022-08-29","2022-11-16","2022-09-15","2022-10-17","2022-08-29","2022-08-29","2022-09-27","2022-10-21","2022-12-05"],"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":[["","23155019101","BUPROPION","TAB 75MG","60","Select","Select",""],["","69238131209","PREGABALIN","CAP 75MG","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16729003515","ANASTROZOLE","TAB 1MG","30","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","25.5","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00168032346","METRONIDAZOL","CRE 0.0075","45","Select","Select",""],["","00193730850","BAYER","NE XT 50CT","50","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","180","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","62135062605","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","42195055014","CIPROFLOXACN","SOL 0.002","14","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","20","Select","Select",""],["","27808003501","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00193737701","CONTOUR","KIT NEXT","1","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","00093322308","ESTRADIOL","TAB 10MCG","24","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","3","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.25","Select","Select",""],["","527058601","DICYCLOMINE","CAP 10MG","20","Select","Select",""],["","93220405","METOCLOPRAM","TAB 5MG","120","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","00000000000","LIDOCAINE","SOL 2% VISC","240","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","100","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","120","Select","Select",""],["","65862051601","NAPROXEN","TAB 550MG","60","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","42","Select","Select",""],["","93031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","781717612","NALOXONE","SPR ","2","Select","Select",""],["","24208063110","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","59762330401","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69452017113","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00000000000","NYSTATIN","SUS 100000","240","Select","Select",""],["","66869040490","LIVALO","TAB 4MG","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}