{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TREBLAPETSE ","gend":0,"add":"               993 XOB OP                         ","city":"COEBURN                  ","state":"VA","zip":"24230-0399","dob":"1958-04-08","age":"","mstatus":"","insh":"00118626","cliId":"","pno":"4367263215","cno":8039739344,"email":"","ename":"","eno":"","pphy":"WINEGAR, J B","ppno":2764312648,"pcpadd":"121 ADVANCED TECHNOLOGY DR,  ","pcpcity":"DUFFIELD","pcpstate":"VA","pcpzip":242440000,"pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"PO BOX 399                                        ","madd2":"                                                  ","madd3":"","mcity":"COEBURN                  ","mstate":"VA","mzip":"24230-0399","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.512","M17.11","J43.9","Z72.0","R06.00","R07.9","J44.9","F33.9","I10","Z79.899","I20.9","G89.29","L82.1","F15.20","I50.9","M51.37","G25.81","G62.9","E78.5","M50.90","M47.816","M51.06","U07.1","S01.81XD","R91.1","R91.8","F17.200","B07.0","J96.91","W19.XXXA","J96.01","J12.82","N17.9","J44.0","I11.0","S01.81XA","S01.412A","E03.9","K21.9","F17.210","Z23","L81.9","F11.20","G89.4","D48.9","F32.9","G47.00","J01.90","J84.9","M51.26","M54.5","C44.622","H60.42","H61.23","M25.511","R06.02","R00.2","L81.4","D22.72","D22.5","L57.0","R07.89","C44.621","R10.11","L98.9","J20.9","R05","M54.2","L60.0","L84","M79.675","T63.441A","M79.604","R21","N40.0","M54.50","S09.8XXA","K26.9","R13.10","Z01.818","Z12.11","Z00.00","M25.569","M79.89","M19.011","M79.669","R10.9","R05.9","I20.8","I27.20","Z79.82","Z83.3","Z82.49","M79.672","M54.17","M71.572","S09.90XA","S19.9XXA","A41.9","Z20.822","M79.641","Z86.73","Z09","Z92.29","Z91.030","F41.9","E78.2","D22.61","C44.329","L72.11","Z08","Z85.828","D23.61","R13.14","Z80.0","L73.9","S39.91XA","S39.93XA","S29.9XXA","R06.83"],"date":["2021-07-08","2022-03-17","2022-05-17","2021-10-25","2020-04-27","2022-03-22","2022-06-30","2022-06-30","2022-07-18","2022-07-18","2022-05-17","2022-06-14","2021-08-25","2022-05-17","2022-06-14","2022-05-17","2022-05-17","2022-03-17","2022-06-14","2021-09-13","2022-07-18","2022-07-18","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2019-11-18","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2021-11-15","2019-10-09","2022-07-18","2020-11-09","2020-07-08","2019-11-11","2020-04-27","2022-01-17","2021-06-14","2020-08-07","2020-10-01","2020-08-12","2021-12-16","2021-12-16","2021-06-14","2022-03-22","2022-03-22","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2020-04-27","2020-08-07","2021-06-03","2020-07-22","2020-04-16","2020-04-16","2022-07-18","2022-01-17","2019-06-10","2019-06-04","2019-07-10","2019-07-05","2019-07-05","2019-07-05","2022-07-18","2022-06-14","2021-05-14","2021-05-14","2019-04-23","2019-04-23","2021-11-15","2019-06-10","2020-07-22","2020-07-22","2020-10-01","2021-10-25","2021-10-25","2020-04-27","2020-04-27","2020-07-22","2020-04-27","2020-04-27","2019-10-02","2019-10-02","2019-10-02","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2020-07-22","2020-07-22","2020-05-01","2020-10-01","2019-07-10","2019-07-10","2019-11-22","2020-08-26","2019-03-11","2020-10-05","2020-10-05","2020-10-05","2019-02-11","2021-09-01","2021-09-01","2020-03-10","2022-06-14","2022-06-14","2022-06-14","2019-12-11"],"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":[["","00378531001","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00093645156","ESOMEPRA","CAP 40MG DR","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","180","Select","Select",""],["","69238131209","PREGABALIN","CAP 75MG","60","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","90","Select","Select",""],["","69097045805","FENOFIBRATE","TAB 145MG","90","Select","Select",""],["","62175010601","ISOSORB","TAB 10MG","180","Select","Select",""],["","68462012705","GABAPENTIN","TAB 800MG","360","Select","Select",""],["","47781026405","OXYCODONE","TAB 15MG","90","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","75","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","00378395377","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00781540292","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","180","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","68462025501","ROPINIROLE","TAB 1MG","180","Select","Select",""],["","61442010201","DICLOFENAC","TAB 50MG DR","180","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","180","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","1,200.00","Select","Select",""],["","00603533928","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","12","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","59762332801","CLINDAMYCIN","CAP 150MG","60","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4,000.00","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":""}]}]}