{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" S YGGEPYELNATS","gend":1,"add":"            ENAL DEER 191                         ","city":"STANLEY                  ","state":"VA","zip":"22851-9998","dob":"1947-08-25","age":"","mstatus":"","insh":"00114376","cliId":"","pno":"4704558492","cno":"","email":"","ename":"","eno":"","pphy":"LEE, ROLAND DAVID","ppno":5407434561,"pcpadd":"200 MEMORIAL DR,","pcpcity":"Luray","pcpstate":"VA","pcpzip":228351000,"pcpcounty":"","pcpid":"","pcpname":"PAGE MEMORIAL HOSPITAL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"P.O. BOX 344                                      ","madd2":"                                                  ","madd3":"","mcity":"STANLEY                  ","mstate":"VA","mzip":"22851-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50.30","G89.4","I73.9","S82.892D","I10","E78.5","N81.4","I25.10","I25.2","I48.91","E03.9","Z79.899","Z79.82","Z79.4","Z79.890","Z79.01","Z88.2","Z88.8","E11.42","F17.210","N32.81","N39.46","L89.323","R29.6","E11.65","R51.9","N81.10","I67.82","G31.9","J01.10","J40","E11.9","R51","S09.90XA","W19.XXXA","J32.0","R55","R42","R53.1","Z09","I95.1","D64.9","S82.852A","Z96.7","S82.852D","D50.9","K04.7","R53.83","D72.829","F41.8","S82.52XD","S82.832D","M77.32","M85.872","Z96.60","F17.200","E78.00","M19.072","Z87.81","M25.472","S93.432A","Z01.818","Z20.828","E10.9","H25.13","H52.4","R11.0","E16.2","E11.649","N83.201","N83.202","F32.9","F41.9","J45.909","Z88.5","N83.291","N83.292","R10.2","F43.9","R05.9","J06.9","R11.2","H66.92","Z20.822","G89.29","R03.1","Z46.89","N89.8","R60.0","R29.898","S31.829D","X58.XXXD","R26.89","Z03.89","R79.89","R19.7","M25.50"," ","Z79.891"],"date":["2022-09-19","2022-09-19","2022-04-26","2022-04-26","2022-09-30","2022-09-30","2021-02-01","2021-02-04","2021-02-01","2022-02-22","2021-02-04","2021-02-01","2021-02-01","2022-09-19","2021-02-01","2022-02-11","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-08-30","2022-03-08","2022-02-22","2022-09-19","2022-07-19","2021-02-04","2022-02-11","2022-02-11","2022-06-28","2022-06-28","2021-08-30","2019-04-25","2019-04-25","2019-04-25","2019-04-25","2021-08-30","2019-06-06","2019-05-12","2019-06-06","2019-05-17","2019-06-03","2020-08-05","2020-06-01","2020-06-01","2019-06-25","2019-06-06","2019-06-06","2019-06-25","2020-10-16","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2019-07-12","2019-12-31","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-17","2020-10-13","2020-09-28","2020-09-28","2020-09-28","2019-10-01","2019-10-01","2019-10-12","2020-10-16","2020-10-16","2020-10-13","2020-11-30","2020-10-13","2020-10-13","2020-10-16","2020-10-16","2020-10-16","2020-11-30","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2019-12-17","2019-12-23","2019-12-27","2019-12-27","2022-03-04","2022-02-22","2022-03-08","2022-03-08","2022-03-08","2022-03-04","2022-04-28","2022-09-19","2022-09-19","2022-11-07","2022-11-07"],"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":[["","57664050083","MIRTAZAPINE","TAB 30MG","90","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","140","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","810","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","180","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","40","Select","Select",""],["","00603497528","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","68180038909","FENOFIBRATE","TAB 145MG","90","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","180","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","20","Select","Select",""],["","60505294509","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70377000911","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","39","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","68382065005","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","90","Select","Select",""],["","55111032201","GLIMEPIRIDE","TAB 4MG","90","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00378180510","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","08290328468","INSULIN","MIS 0.5\/31G","100","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","180","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21.00","Select","Select",""],["","70069000701","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","93216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","40","Select","Select",""],["","59011042010","OXYCONTIN","TAB 20MG CR","60","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","180","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","200","Select","Select",""],["","60913000601","ALCOHOL","PAD ","200","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073014002","FREESTYLE    LIQ CONTROL","LIQ CONTROL","1","Select","Select",""],["","60913000101","AQUALANCE","MIS 30G","300","Select","Select",""],["","38415051208","AQUA","MIS LANC DEV","1","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00093573201","OXYCODONE","TAB 20MG ER","60","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":""}]}]}