{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S MAILLIWRS ELEET","gend":0,"add":"         teerts niam 0171                         ","city":"CLIFTON FORGE            ","state":"VA","zip":"24422-9998","dob":"1973-05-07","age":"","mstatus":"","insh":"00117048","cliId":"","pno":"5904500898","cno":"","email":"","ename":"","eno":"","pphy":"NEAL, THOMAS WILLIAM","ppno":5405873364,"pcpadd":"1613 OAKWOOD ST,  ","pcpcity":"Bedford","pcpstate":"VA","pcpzip":245231213,"pcpcounty":"","pcpid":"","pcpname":"CMG SCC BEDFORD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT 323                                           ","add3":"","madd1":"1710 MAIN STREET                                  ","madd2":"APT 323                                           ","madd3":"","mcity":"CLIFTON FORGE            ","mstate":"VA","mzip":"24422-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z43.0","Z79.891","Z79.899","G89.4","R69","K21.9","F51.01","E03.9","R56.9","E78.5","Z11.59","M80.88XA","M51.36","Z93.0","R51","Z85.9","M79.2","F91.9","R49.1","R13.12","Z90.02","T17.908A","G89.29","K59.03","Z51.5","G89.3","R51.9","T40.2X5A","C32.9","R63.4","Z85.21","R45.4","Z92.3","M54.5","L08.9","R21","I80.8","I82.621","I82.413","Z71.89","M48.04","M48.07","M48.05","S22.080A","M51.44","M51.85","M47.815","M47.816","M48.061","M47.817","M46.1","G47.01","A63.0","G89.28","Z86.69","F11.90","Z08","M47.812","L03.818","F41.9","R04.2","Z51.81","F39","G40.802","G47.00","Z87.820","I10","E78.00","G25.81","J45.909","Z85.22","Z13.6","Z13.1","Z13.29","B19.20","S61.219A","W26.0XXA","G40.909","E07.9","Z79.890","Z87.891","Z86.718","R47.02","Z01.818","Z01.810","Z45.42","F60.3","Z85.819","F51.04","Z13.220","R41.3","Z76.89","R78.81","C32.0","R05","Z86.59","K62.9","Z20.822","R68.89","L02.92","S32.030A","X58.XXXA","L72.9","L90.5","Z87.898","R11.0","Z85.89"],"date":["2022-07-12","2020-09-11","2020-09-11","2022-06-22","2022-03-14","2021-08-26","2021-04-12","2022-03-22","2022-04-14","2022-06-22","2022-06-22","2020-10-05","2020-10-05","2022-06-22","2020-09-11","2020-08-14","2020-09-11","2022-04-14","2022-06-23","2020-07-31","2022-06-23","2022-06-23","2022-05-06","2022-02-25","2022-05-06","2022-02-25","2022-02-25","2022-02-25","2022-05-06","2022-06-22","2022-02-25","2022-03-30","2022-02-25","2020-09-11","2020-07-09","2020-11-17","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-09-15","2021-07-30","2020-09-11","2020-03-13","2021-06-21","2021-08-20","2020-01-24","2019-11-14","2021-07-01","2021-08-03","2022-05-20","2020-11-17","2020-11-17","2022-06-22","2022-04-14","2022-03-22","2021-10-07","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-04-20","2019-10-14","2019-10-14","2022-06-22","2021-08-03","2021-08-03","2021-08-03","2021-07-07","2021-07-07","2021-07-07","2021-10-22","2021-10-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-03-30","2022-03-30","2020-01-30","2021-02-19","2021-08-03","2021-05-26","2021-06-18","2021-08-03","2021-08-03","2021-07-30","2020-08-21","2020-08-21","2021-06-18","2021-06-18","2022-03-22","2022-05-06","2022-05-06"],"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":[["","16714087603","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00000000000","ZONISAMIDE","CAP 100MG","1,200.00","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","00378041501","DIPHEN\/ATROP","TAB 2.5MG","30","Select","Select",""],["","68382010601","DIVALPROEX","CAP 125MG","480","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","43547034406","RISPERIDONE","TAB 4MG","30","Select","Select",""],["","60432062116","VALPROIC","SOL 250\/5ML","473","Select","Select",""],["","51672404709","CARBAMAZEPIN","SUS 100\/5ML","450","Select","Select",""],["","43598074130","RAMELTEON","TAB 8MG","30","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","90","Select","Select",""],["","16714008212","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","00703868023","ENOXAPARIN","INJ 80\/0.8ML","48","Select","Select",""],["","42858080101","MORPHINE","TAB 15MG ER","90","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","130","Select","Select",""],["","68180097103","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","180","Select","Select",""],["","00121081016","NYSTATIN","SUS 100000","473","Select","Select",""],["","71858014005","TIROSINT-SOL","SOL 125MCG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00093415580","AMOXICILLIN","SUS 250\/5ML","150","Select","Select",""],["","16714095501","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","62332003331","ROPINIROLE","TAB 2MG","30","Select","Select",""],["","51991070605","ALPRAZOLAM","TAB 1MG","90","Select","Select",""],["","68180032301","ESZOPICLONE","TAB 2MG","30","Select","Select",""],["","50111056102","TRAZODONE","TAB 100MG","30","Select","Select",""],["","52817032000","BACLOFEN","TAB 10MG","60","Select","Select",""],["","52652300101","QBRELIS","SOL 1MG\/ML","900","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","45802036862","IMIQUIMOD","CRE 0.05","24","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","67877031905","IBUPROFEN","TAB 400MG","15","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","20","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":""}]}]}