{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" C SEMAJNOSDIVAD","gend":0,"add":"      DR NWOT REBIMIK 949                         ","city":"FORT BLACKMORE           ","state":"VA","zip":"24250-9998","dob":"1958-03-06","age":"","mstatus":"","insh":"00116792","cliId":"","pno":"5467221012","cno":2764521012,"email":"","ename":"","eno":"","pphy":"PROVANCE, PAUL","ppno":2763865980,"pcpadd":"1754 US HIGHWAY 23 N,","pcpcity":"Weber City","pcpstate":"VA","pcpzip":242907071,"pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"949 KIMIBER TOWN RD                               ","madd2":"                                                  ","madd3":"","mcity":"FORT BLACKMORE           ","mstate":"VA","mzip":"24250-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.10","I50.1","R94.39","R06.02","J44.9","K21.9","E78.5","E03.9","F17.210","Z85.820","Z80.1","Z83.3","Z82.49","B36.0","D22.5","D22.61","D22.62","L82.1","L81.4","Z85.828","L57.0","M50.30","Z79.899","M25.562","M79.605","S89.92XA","S72.002A","I48.91","F11.20","S72.009A","W18.30XA","I10","Z20.822","Z85.118","Z92.21","D64.9","E55.9","G89.29","Z87.891","W18.39XA","S72.042A","W19.XXXA","Z01.811","M25.552","C7A.1","C34.91","Z08","Z01.810","C34.11","J93.82","R59.0","Z79.82","Z79.891","Z01.818","R91.1","J43.9","Z01.812","R91.8","C44.311","D48.5","F43.22","G31.84","R35.0","M51.36","Z00.00","Z12.11","Z28.20","C34.90","S72.002D","N18.3","R42","R90.82","Z51.11","Z51.12","M54.5","M54.2","F41.8","M47.22","R35.1","Z76.89","I16.0","J01.40","R11.0","Z51.89","T45.1X5A","R94.5","I12.9","F32.9","Z95.828","Z29.9","D70.1","R53.1","R79.9","D72.819","R05","D70.9","D61.818","Z90.2","N20.0","D73.89","F17.200","R94.4","J98.4","J98.11","J90","J84.10","D64.81","T45.1X5D","C77.9","C80.1","Z45.2","N18.30","K91.1","Z51.0","J34.89","M48.02","M25.50"," ","R29.6","F32.A","I70.0"],"date":["2019-03-22","2019-01-02","2019-01-02","2022-05-02","2022-10-24","2022-04-11","2022-10-24","2022-10-24","2019-01-02","2019-01-02","2019-01-02","2019-01-02","2019-01-02","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-10-24","2022-10-31","2022-04-11","2022-01-11","2022-01-11","2022-02-10","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-10-24","2022-01-11","2022-01-14","2022-01-11","2022-01-11","2022-04-11","2022-01-11","2022-01-11","2022-01-11","2022-01-13","2022-01-14","2022-01-11","2022-01-12","2022-11-18","2022-11-18","2020-08-18","2019-01-17","2019-03-13","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2019-01-18","2019-02-01","2020-07-21","2019-01-18","2019-01-22","2021-02-10","2021-01-28","2022-01-28","2022-01-28","2021-02-02","2022-07-11","2022-02-10","2021-02-02","2021-02-02","2022-07-11","2022-02-22","2020-04-23","2022-10-24","2020-03-05","2019-05-01","2019-04-10","2018-05-25","2018-05-25","2018-05-25","2018-05-25","2018-03-14","2018-03-14","2019-03-22","2018-03-27","2019-04-10","2019-05-01","2019-09-26","2020-07-21","2020-04-23","2019-11-26","2019-09-26","2019-05-01","2019-05-30","2022-02-02","2019-05-30","2019-05-30","2019-05-30","2019-05-30","2019-05-30","2020-07-21","2020-07-21","2020-07-21","2018-09-05","2021-09-13","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-26","2019-09-26","2018-10-10","2018-10-10","2019-10-02","2022-10-24","2018-10-22","2019-11-01","2020-11-03","2018-12-26","2022-06-08","2022-11-18","2022-11-18","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":[["","68180096503","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120.00","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30.00","Select","Select",""],["","00093077198","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","30.00","Select","Select",""],["","27808003601","HYDROCO\/APAP","TAB 7.5-325","120","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","43547028210","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","60","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","28","Select","Select",""],["","13107004401","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","00000000000","PROMETHAZINE","TAB 50MG","12","Select","Select",""],["","68382022705","AMIODARONE","TAB 200MG","60","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","68462024805","RANITIDINE","TAB 150MG","30","Select","Select",""],["","00456140530","BYSTOLIC","TAB 5MG","30","Select","Select",""],["","62332000931","VENLAFAXINE","TAB 37.5MG","180","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","60","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","13668011310","LOSARTAN","TAB 25MG","90","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":""}]}]}