{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A YRAMSNIKT","gend":1,"add":"          EVA NERRAW 5231                         ","city":"FRONT ROYAL              ","state":"VA","zip":"22630-9998","dob":"1952-02-04","age":"","mstatus":"","insh":"00118309","cliId":"","pno":"3604500731","cno":3049957958,"email":"","ename":"","eno":"","pphy":"FINEFROCK, DAWNYA","ppno":5406367000,"pcpadd":"841 N SHENANDOAH AVENUE,","pcpcity":"FRONT ROYAL","pcpstate":"VA","pcpzip":22630,"pcpcounty":"","pcpid":"","pcpname":"SKYLINE MEDICAL PRACTICE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1325 WARREN AVE                                   ","madd2":"                                                  ","madd3":"","mcity":"FRONT ROYAL              ","mstate":"VA","mzip":"22630-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.22","N18.6","Z99.2","E87.70","J96.01","J90","I11.0","R06.02","I50.9","I48.0","E78.5","Z20.822","Z92.89","I13.2","H54.8","R39.81","I10","R13.12","D64.9","D63.8","R03.0","D50.9","D63.1","E55.9","N18.9","N18.5","N25.81","J42","E11.9","I48.92","H92.21","R41.0","Z79.4","Z12.31","E53.8","R68.89","H53.433","E11.51","B35.1","E11.3492","E11.3511","H35.373","Z96.1","H04.123","E11.42","I50.33","J94.8","J91.8","K76.1","J45.909","F32.9","I49.9","I48.91","R09.02","R06.89","J98.11","J81.1","J98.4","I12.9","E87.6","J98.19","E05.90","R74.9","I50.30","Z79.01","Z23","J93.9","R22.1","R91.8","K21.9","H92.22","R71.8","J96.90","N19","I50.32","J45.20","J20.9","H90.5","M54.9","J18.9","E11.3591","H31.9","H34.11","T82.590A","I87.1","T82.510A","Y83.2","T82.898A","R69","I12.0","R11.2","R10.9","E11.8","R77.8","I50.21","I48.20","E87.1","E87.79","I95.3","Z91.15","Z01.810","Z01.818","I47.2","E87.2","N17.9","I08.1","H91.90","E83.51","Z98.42","J81.0","J96.91","Z74.3","Z90.49","S09.90XA","I13.0","R29.6","R06.9","R00.0","R06.2","N17.0","N39.0","F05","E87.5","R00.1","R07.89","R07.9","Z45.2","I42.9","I67.9","R53.83","H47.20","H47.293","H47.213","G31.9","I67.82","R13.10","H61.22","H53.16","R05","R93.3","T82.858A","M54.5","E11.359","W54.0XXA","S01.411A","S01.81XA","S01.511A","R58","W55.81XA","S01.85XA","R22.0","R93.5","J69.0","W54.0XXD","E43","Z68.22","I48.19","R11.11","J98.9","I50.22","M47.812","M51.36","F29","R42","R11.0","R53.1","R06.00","Z09","J44.9","R09.89","R41.82","E07.9","Z13.89","I50.20","T82.49XA","R60.9","F32.A","Z98.41","Z88.6","S00.411A","I74.2","Z86.79","J30.1","F41.9","I38","Z00.00","F03.90","R41.89","T82.868A","E11.3292"," "],"date":["2022-11-29","2022-11-10","2022-11-02","2021-04-19","2021-07-20","2022-06-02","2022-02-10","2022-02-10","2022-11-08","2022-11-01","2022-11-29","2022-02-10","2021-09-17","2022-08-02","2022-11-08","2022-11-08","2022-11-08","2021-11-30","2022-09-27","2021-11-30","2021-08-01","2022-11-02","2022-11-02","2022-07-14","2021-08-27","2022-11-29","2021-09-01","2021-12-02","2022-12-06","2022-07-14","2021-12-07","2022-01-27","2022-11-29","2022-11-01","2021-12-09","2021-12-09","2021-05-20","2022-09-20","2022-09-20","2022-03-08","2020-12-15","2022-09-22","2020-12-15","2020-12-15","2019-12-18","2021-04-19","2021-01-08","2021-07-11","2021-01-01","2022-06-06","2021-08-27","2021-05-27","2022-01-18","2021-07-21","2022-02-10","2021-07-21","2021-08-17","2021-01-01","2022-10-01","2021-04-05","2021-01-06","2021-01-06","2021-01-02","2021-08-05","2021-08-27","2022-11-02","2021-01-10","2021-01-05","2021-10-28","2022-02-10","2022-01-25","2020-01-27","2021-01-29","2021-01-29","2022-07-21","2022-06-02","2022-02-10","2020-02-13","2021-03-02","2022-11-18","2022-09-22","2022-09-22","2021-05-20","2022-08-02","2022-10-20","2021-03-25","2021-03-25","2021-03-25","2020-04-01","2021-07-11","2021-04-06","2021-04-05","2021-04-05","2021-04-07","2021-07-11","2021-04-19","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2020-04-08","2021-11-13","2020-04-20","2021-04-19","2021-08-27","2021-04-19","2020-04-10","2020-04-10","2021-11-17","2021-07-11","2021-04-19","2020-04-20","2021-11-17","2021-04-19","2021-08-27","2021-04-19","2021-07-11","2021-08-13","2021-04-19","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-21","2022-07-14","2022-07-14","2021-05-04","2020-05-13","2020-05-13","2022-09-22","2020-05-13","2020-05-13","2021-10-05","2021-05-18","2022-09-22","2021-05-25","2021-05-25","2022-11-10","2020-08-10","2021-06-24","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-02","2021-07-02","2021-07-08","2021-07-03","2021-07-08","2021-07-20","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-23","2020-08-10","2020-08-10","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-09-16","2022-11-01","2021-08-27","2021-08-27","2021-09-17","2019-10-01","2021-10-12","2022-11-10","2019-11-13","2022-11-01","2021-11-17","2021-11-17","2021-11-23","2019-11-27","2022-07-14","2022-06-02","2022-11-01","2022-07-14","2022-07-14","2022-07-21","2022-08-23","2022-09-19","2022-09-22","2022-12-06"],"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":[["","56151146004","TRUE","TES GLUCOSE","300","Select","Select",""],["","16714087403","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00378967160","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","00003089321","ELIQUIS","TAB 2.5MG","60","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","63304072190","DILTIAZEM","CAP 300MG ER","30","Select","Select",""],["","16714083201","BUMETANIDE","TAB 1MG","30","Select","Select",""],["","61442012101","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","62037060090","CARTIA","CAP 300\/24HR","30","Select","Select",""],["","49884029004","MEGESTROL","TAB 40MG","30","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","00093735201","CALCITRIOL","CAP 0.25MCG","30","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","23","Select","Select",""],["","51862024030","AMIODARONE","TAB 100MG","60","Select","Select",""],["","00093729505","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","56151014701","TRUPLUS","MIS 33G","100","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","68462056417","MUPIROCIN","CRE 0.02","15","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","14","Select","Select",""],["","58160081912","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","16714002610","ENOXAPARIN","INJ 60\/0.6ML","0.6","Select","Select",""],["","59746021110","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00781502207","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00781730431","RIVASTIGMINE","DIS 4.6MG\/24","30","Select","Select",""],["","08517389036","UNIFINE","MIS 31GX6MM","100","Select","Select",""],["","43547027609","DONEPEZIL","TAB 10MG","25","Select","Select",""],["","00005197102","PREVNAR","INJ ","0.5","Select","Select",""],["","50383002505","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","16714008110","HYDROXYZ","TAB 10MG","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","68382073901","MIDODRINE","TAB 10MG","20","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","60","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","15","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","56151210201","PEN  NEEDLES","MIS 31GX6MM","100","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":""}]}]}