{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" D KNARFLLEBPMAC","gend":0,"add":"   WS EUNEVA REROR   3221                         ","city":"ROANOKE                  ","state":"VA","zip":"24016-3309","dob":"1957-05-21","age":"","mstatus":"","insh":"00119453","cliId":"","pno":"3304574929","cno":5409154865,"email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO D","ppno":5407693964,"pcpadd":"7768 WILLIAMSON RD,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240194343,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSAL HEALTH CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1223   RORER AVENUE SW                            ","madd2":"                                                  ","madd3":"","mcity":"ROANOKE                  ","mstate":"VA","mzip":"24016-3309","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.1","Z11.4","Z11.59","Z23","M10.9","Z12.11","E87.6","M79.671","M79.672","R05.3","R53.81","F17.200","Z79.82","Z20.822","R53.83","R06.02","I77.1","I70.0","Z09","F10.11","R63.0","F32.A","G47.9","I10","R80.9","Z72.0","Z97.4","D64.9","F43.20","Z74.3","Z76.0","Z68.32","H90.3","H90.5","D50.8","K21.9","R79.89","H54.7","H91.93","F43.21","H57.13","H57.89","H53.143","H92.03","R09.89","F17.210","Z79.899","M10.022","M10.062","M25.522","H91.90","H25.813","H11.133","H04.123","H52.03","H52.223","H52.4","S52.002A","W10.9XXA","S52.122A","S52.125A","Z04.3","R41.82","R51","T14.90XA","H04.209","S52.135A","R00.0","I95.9","R10.12","V49.9XXA","Y93.89","Y92.410","Z04.1","F10.129","M54.5","F10.920","V89.2XXA","X58.XXXA","M00.9","L03.011","M25.441","M25.541","M25.531","R60.9","M79.641","A41.9","R60.0","M79.644","Z87.39","M79.89","M25.50","F52.0","M10.071","M25.40","R74.01","G93.89","M25.562","G93.6","G06.0","K55.1","G40.901","K80.20","Z86.61","Z79.1","Z79.2","Z79.01","Z82.49","Z79.02","C71.9","G40.219","G40.201","R13.10","D49.6","G40.109","S06.2X0D","D72.829","K59.00","E46","S06.5X9A","M25.561","W19.XXXA","I62.00","I61.1","E87.8","D51.9","R73.03","F10.10","F14.90","R94.31","W01.0XXA","S06.5X0A","S01.112A","S60.511A","R09.02","W10.8XXA","Y93.G3","Y92.000","E87.1","G89.11","M25.461","S50.812A","E83.42","S06.5X9D","W19.XXXD","S80.211A","S80.212A","R26.89","R45.1","Z03.89","G40.101","G81.94","R41.4","R48.2","M21.40","R13.12","R45.87","M62.81","R26.2","R41.841","Z68.28","K92.2","K62.5","E51.9","D75.839","E55.9","E16.2","D51.8","R73.9","G40.89","G47.00","R51.9","R41.89","M25.572","S01.81XA","T07.XXXA","E87.2","F39","D12.2","K57.30","K64.0","K57.31","D62","F17.290","L08.89","M89.8X4","S06.0X0A","S01.21XA","S00.83XA","S09.90XA","E78.5","L60.2","H53.9","M1A.9XX1","Z76.89","R29.6","S01.91XA","W13.0XXA","Y93.9","Y92.9","S06.5X0D","F41.9","F10.21","I62.9","Z98.890","M25.521","S93.402D","S99.919A","B35.1","M79.674","M79.675","M19.042","J40","R06.2","R05.9","R07.81","R23.8","M54.50","R10.9","J21.9","J06.9","S93.402A","Y93.01","Y92.89"," ","M19.072","M19.071","M13.871"],"date":["2022-04-15","2021-01-13","2021-01-13","2022-09-09","2022-10-13","2021-01-13","2022-03-16","2022-12-05","2022-12-05","2022-01-23","2022-01-23","2022-04-04","2022-01-23","2022-10-18","2022-01-23","2022-05-05","2022-01-23","2022-01-23","2022-11-02","2022-07-28","2022-01-27","2022-07-28","2022-07-28","2022-07-26","2020-01-30","2022-07-26","2020-01-30","2022-05-06","2020-01-30","2022-10-18","2019-02-28","2019-04-02","2019-04-16","2019-04-22","2021-05-17","2022-07-28","2021-05-17","2021-05-17","2022-10-12","2021-05-17","2021-06-17","2021-07-24","2021-06-17","2021-06-17","2019-06-18","2022-10-18","2022-10-18","2019-06-25","2019-06-25","2022-04-04","2022-07-07","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2020-07-16","2022-04-06","2020-07-16","2020-07-16","2022-05-05","2020-07-16","2020-07-16","2021-08-06","2021-07-24","2020-07-30","2021-08-06","2022-05-05","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2022-09-28","2021-09-13","2021-09-14","2021-09-13","2021-09-13","2021-09-13","2022-09-30","2021-09-16","2022-05-05","2021-09-13","2021-09-15","2022-11-02","2022-04-13","2022-09-09","2018-10-17","2019-12-12","2018-12-26","2022-03-04","2022-04-27","2022-09-30","2022-02-22","2022-04-04","2022-03-04","2022-02-22","2022-02-15","2022-05-05","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-03-04","2022-03-04","2022-02-27","2022-02-27","2022-02-22","2022-04-04","2022-03-14","2022-07-14","2022-03-24","2022-03-24","2022-04-27","2022-09-30","2022-09-28","2022-07-26","2022-02-27","2022-04-09","2022-04-09","2022-04-09","2022-07-07","2022-04-11","2022-04-04","2022-09-28","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-07-14","2022-04-04","2022-04-08","2022-04-04","2022-04-08","2022-04-12","2022-04-12","2022-04-04","2022-04-04","2022-07-26","2022-04-12","2022-04-05","2022-03-04","2022-03-04","2022-03-04","2022-04-04","2022-03-04","2022-04-04","2022-03-04","2022-04-14","2022-09-19","2022-04-12","2022-04-01","2022-05-06","2022-05-06","2022-04-15","2022-04-08","2022-07-26","2022-04-08","2022-04-08","2022-04-08","2022-03-24","2022-03-24","2022-03-31","2022-04-08","2022-09-28","2022-07-14","2022-04-04","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-05-05","2022-05-06","2022-05-05","2021-09-15","2021-09-15","2022-07-14","2022-07-14","2022-07-14","2022-09-28","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-28","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-07-26","2022-07-26","2022-07-26","2022-02-26","2022-02-26","2022-09-28","2022-09-30","2022-09-28","2022-09-19","2022-09-19","2022-09-19","2022-09-09","2022-11-02","2022-10-18","2022-10-18","2022-10-18","2021-09-14","2022-09-28","2022-10-18","2022-10-18","2022-11-02","2022-09-28","2022-09-28","2022-09-28","2022-12-05","2022-12-05","2022-12-05","2022-12-05"],"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":[["","27241009706","DULOXETINE","CAP 20MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30.00","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59651017501","DOXEPIN","CAP 50MG","30","Select","Select",""],["","00378064010","PREDNISONE","TAB 5MG","48","Select","Select",""],["","68180011507","LEVETIRACETA","TAB 1000MG","60.00","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","15.00","Select","Select",""],["","70710120901","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","15.00","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","8.00","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0.30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","30","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","15","Select","Select",""],["","31722054301","INDOMETHACIN","CAP 50MG","30","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":""}]}]}