{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M YHTAKEUDREP ","gend":1,"add":"       DR SSENREDLIW 2006                         ","city":"DUBLIN                   ","state":"VA","zip":"24084-9998","dob":"1961-02-12","age":"","mstatus":"","insh":"00113487","cliId":"","pno":"7604561114","cno":5403924398,"email":"","ename":"","eno":"","pphy":"REBKOVICH, KELLY N","ppno":2769888850,"pcpadd":"141 BEN BOLT AVE,","pcpcity":"Tazewell","pcpstate":"VA","pcpzip":246519700,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"P.O. BOX 726                                      ","madd2":"                                                  ","madd3":"","mcity":"DUBLIN                   ","mstate":"VA","mzip":"24084-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","J44.1","R06.02","J96.01","Z20.828","F32.9","M54.9","G89.29","F17.200","K21.9","G43.909","Z79.51","Z87.11","Z79.2","Z79.52","Z88.1","Z88.8","S39.012A","S13.9XXA","V49.40XA","M54.2","N89.8","N88.9","R82.998","Z12.2","R91.8","Z87.891","H04.123","F51.01","J42","E78.2","J96.11","R06.2","K29.50","K29.70","E55.9","E78.5","J44.9","K21.0","Z59.00","R10.13","R12","R11.0","K21.00","K22.8","Z04.1","T14.90XA","R00.1","R73.03","E83.51","R73.01","Z20.5","Z12.39","F06.4","F41.8","F43.10","K27.9","M19.90","M47.9","Z20.822","Z66","R09.02","Z12.31","Z13.820","Z78.0","M81.0","K92.1","R10.9","K20.90","R30.0","R10.32","K30","R20.2","M54.5","V87.7XXD","M25.511","M25.512","R06.00","M81.8","S13.4XXA","V43.52XA","Y92.410","L98.9","C44.311","M54.6","L28.1","L81.4","D48.5","L82.1","Z08","Z85.828","S93.402A","M25.562","W10.9XXA","Y92.009","S86.912A"," ","S89.92XA","R19.8","S86.812A","S93.401A","W10.8XXA"],"date":["2021-05-25","2022-08-18","2021-12-27","2020-06-25","2020-06-25","2021-03-13","2021-12-28","2020-06-25","2022-11-17","2021-12-28","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2021-07-31","2021-07-31","2021-07-31","2021-11-01","2021-10-06","2021-09-17","2021-10-29","2022-11-17","2022-11-17","2021-12-26","2021-11-16","2021-02-15","2021-05-18","2022-08-15","2021-03-13","2020-06-25","2021-08-04","2021-08-11","2022-03-21","2021-08-04","2022-10-24","2019-12-18","2022-03-21","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-31","2021-07-31","2021-08-02","2022-03-21","2022-03-21","2020-07-07","2020-07-07","2021-05-18","2021-12-26","2021-12-28","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2022-08-18","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-07-03","2021-07-03","2021-08-11","2021-09-17","2021-12-26","2021-07-03","2021-08-09","2021-08-09","2021-09-17","2022-03-21","2021-08-09","2021-12-26","2021-05-28","2021-07-31","2021-07-31","2021-07-31","2022-03-21","2022-06-21","2021-11-01","2022-04-22","2022-10-05","2022-04-22","2022-10-05","2022-10-05","2022-10-05","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-11-17","2022-10-24","2022-11-17","2022-10-24","2022-10-24","2022-10-24"],"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":[["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","00093077198","PRAVASTATIN","TAB 10MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","25.5","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","43386009662","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","58160081912","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0.5","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","5","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","10","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","40","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","54.00","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0.5","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","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":""}]}]}