{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" L NERAKREKANOH","gend":1,"add":"           DR DNALKAO 901                         ","city":"SWORDS CREEK             ","state":"VA","zip":"24649-9998","dob":"1968-05-19","age":"","mstatus":"","insh":"00114405","cliId":"","pno":"7867292053","cno":"","email":"","ename":"","eno":"","pphy":"ABDUL JAWAD, SAMI S","ppno":2765966786,"pcpadd":"6719 GOVERNOR GC PEERY HWY STE 3650,","pcpcity":"Richlands","pcpstate":"VA","pcpzip":246410320,"pcpcounty":"","pcpid":"","pcpname":"CLINCH PROFESSIONAL PHYSICIAN SERVICES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"P.O. BOX 1692                                     ","madd2":"                                                  ","madd3":"","mcity":"HONAKER                  ","mstate":"VA","mzip":"24260-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","J20.8","E66.01","E11.9","I10","Z86.73","Z99.3","I63.9","N39.3","R39.15","N39.41","N39.46","K74.60","R77.2","K76.0","R25.2","G81.11","H16.223","G24.5","H16.143","I69.351","R26.81","I69.320","E11.42","I11.9","Z79.84","K21.9","E78.2","R35.0","Z11.59","F41.9","R56.9","R53.1","N39.0","E87.6","E55.9","R94.5","R79.9","I69.354","G81.91","G81.94","I69.391","R13.10","G46.3","K74.69","D69.6","K29.50","K29.80","Z87.891","Z87.440","Z79.899","R07.2","R07.89","R39.11","R47.1","J98.4","R31.29","H25.13","H02.204","R93.1","R07.9","F41.1","G40.909","B18.1","F03.91","F32.9","E78.5","R10.32","I69.951","R13.12","J06.9","K29.70","H61.21","M40.209","I69.392","Z68.42","Z12.31","H16.142","G62.9","G81.10","R68.89","R39.81","G46.4","R30.0","R53.83","R47.81","R69","Z00.00","K59.00","H57.89","B00.1","I69.998","Z23","Z51.81","M62.81","G47.30","R01.1","K59.09","Z68.41","R09.02","Z82.49","Z28.21","R05","I69.322","R26.9","R25.1","M79.2","R19.5","Z98.890","K29.90","R79.89","Z12.39","D24.9","R41.0","I69.959","R91.8","J43.9","R05.9","E72.20","Z20.822","R41.82","E72.4","R94.2","I51.7","R13.13","J69.0","Z87.898","R06.02","Z79.4","K31.84","K22.2","K72.90","F32.A","J45.909"," "],"date":["2022-11-08","2019-01-26","2022-08-29","2022-11-16","2022-07-19","2022-06-03","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-08-15","2019-01-30","2022-09-09","2022-04-06","2022-11-17","2022-05-12","2020-05-20","2022-05-12","2021-06-11","2019-06-01","2019-06-01","2022-07-19","2019-06-01","2022-05-01","2022-09-09","2022-05-01","2020-06-08","2020-08-18","2022-08-29","2022-05-01","2022-08-25","2022-08-13","2021-12-06","2022-04-06","2021-12-15","2021-12-15","2019-12-17","2022-04-14","2019-12-17","2020-06-05","2020-12-16","2020-02-01","2022-10-27","2022-10-27","2019-01-10","2019-01-10","2022-09-09","2019-01-10","2022-09-09","2019-03-02","2020-02-10","2020-02-10","2020-02-17","2022-09-28","2020-06-29","2022-05-12","2021-10-14","2020-03-31","2021-05-25","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2022-06-03","2021-11-17","2022-10-27","2020-11-25","2021-12-06","2019-01-10","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2020-08-28","2020-09-17","2022-09-09","2022-04-06","2021-02-12","2021-05-24","2019-10-03","2022-03-17","2019-11-07","2020-02-17","2020-02-17","2021-04-27","2021-04-27","2021-04-27","2020-05-12","2018-11-19","2019-11-04","2018-11-19","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2019-01-25","2019-01-25","2019-01-25","2019-01-25","2020-02-17","2022-08-29","2019-03-02","2019-03-02","2019-03-02","2020-04-08","2020-08-31","2019-01-10","2021-02-11","2019-08-28","2019-08-28","2022-03-17","2019-01-23","2022-03-17","2022-03-17","2022-02-18","2022-04-06","2022-04-18","2022-11-16","2022-04-22","2022-05-05","2022-06-01","2022-09-09","2022-09-28","2022-06-27","2022-09-28","2022-07-19","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-11-17"],"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":[["","00527133701","BACLOFEN","TAB 20MG","15","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","30","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","90","Select","Select",""],["","60505058604","OLOPATADINE","SOL 0.002","2.5","Select","Select",""],["","62037099910","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","360","Select","Select",""],["","65862014205","CARVEDILOL","TAB 3.125MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","62175089043","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00093526456","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","30","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","13668010210","DONEPEZIL","TAB 5MG","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00023392102","BOTOX","INJ 200UNIT","1","Select","Select",""],["","16571041110","CIPROFLOXACN","TAB 250MG","6","Select","Select",""],["","00591024110","LORAZEPAM","TAB 1MG","135","Select","Select",""],["","00409330803","ACETYLCYST","SOL 0.2","60","Select","Select",""],["","68180011216","LEVETIRACETA","TAB 250MG","270","Select","Select",""],["","13668014090","PIOGLITAZONE","TAB 15MG","90","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN OP","3.5","Select","Select",""],["","57237004330","VALACYCLOVIR","TAB 1GM","8","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","5.00","Select","Select",""],["","45963043965","CONSTULOSE","SOL 10GM\/15","210.00","Select","Select",""],["","69543010250","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00487950160","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","70010013505","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","10","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","5","Select","Select",""],["","64380080438","RANITIDINE","TAB 300MG","90","Select","Select",""],["","00574416035","NEO\/POLY\/DEX","OIN 0.1% OP","3.5","Select","Select",""],["","51672416403","METRONIDAZOL","GEL 0.01","60","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00065853302","CIPRODEX","SUS 0.3-0.1%","7.5","Select","Select",""],["","00000000000","ACYCLOVIR","TAB 800MG","1","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":""}]}]}