{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EHPOTSIRHCTTROHS A R","gend":0,"add":"            TTROHS EINNOB                         ","city":"WISE                     ","state":"VA","zip":"24293-2719","dob":"1959-08-25","age":"","mstatus":"","insh":"10110608","cliId":"","pno":"2367283988","cno":"","email":"","ename":"","eno":"","pphy":"BASHAM, CHRISTOPHER M","ppno":2765236715,"pcpadd":"323 CLOVERLEAF SQ STE 1,","pcpcity":"Big Stone Gap","pcpstate":"VA","pcpzip":242192760,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"PO BOX 2719                                       ","add3":"","madd1":"BONNIE SHORTT                                     ","madd2":"PO BOX 2719                                       ","madd3":"","mcity":"WISE                     ","mstate":"VA","mzip":"24293-2719","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N30.01","E16.2","G40.909","Z86.39","E22.2","F79","A41.9","R65.21","J69.0","K72.00","N39.0","N17.9","I13.0","E87.1","E87.2","Z75.1","Z86.16","Z79.899","Z20.822","R13.10","Z66","N40.0","Z87.440","U07.1","I10","E11.649","E78.5","F32.9","M81.0","F39","J31.0","R32","R41.89","I95.9","R57.9","A04.72","R33.9","Z68.22","Z68.21","M62.81","T83.511A","Y82.9","Y92.009","A41.52","E87.0","E78.00","E86.0","F71","R39.81","R50.9","N30.80","A41.89","G40.89","R41.82","R56.9","Z68.23","N30.00","N41.9","B35.3","E11.9","B35.1","M79.672","M79.671","R06.02","R65.20","I48.91","N28.1","N32.89","K62.89","Z46.82","J98.11","J96.90","J90","R91.8","J98.4","R60.0","I51.7","D64.9","Z68.25","Y84.6","A41.50","E55.9","N18.9","R33.8","Z51.5","R53.1","R00.0","R74.01","D69.59","D72.829","D69.6","D50.9","D63.1","R94.31","I34.0","R07.89","R07.9","I50.9","K21.9","R03.1","I25.10","N18.6","D63.8","Z86.73","I12.0","E11.22","Z99.2","I25.2","M19.90","G47.33","Z99.3","M20.41","L08.89","M79.674","M79.675","M62.40","M62.461","M62.462","M79.89","I49.1"," ","L01.00","E78.2"],"date":["2021-09-13","2021-09-13","2022-12-06","2022-06-25","2022-10-06","2022-12-06","2022-02-11","2022-02-15","2022-02-01","2022-02-01","2022-02-16","2022-02-14","2022-02-01","2022-02-01","2022-02-07","2022-02-01","2022-02-01","2022-12-06","2022-02-01","2022-11-29","2022-02-01","2022-11-16","2022-02-01","2021-08-25","2022-11-16","2021-08-26","2022-10-06","2021-08-10","2021-08-01","2021-08-26","2021-08-01","2021-08-01","2021-08-01","2022-02-07","2021-08-25","2021-08-25","2022-02-16","2022-02-05","2022-02-04","2022-11-29","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2022-11-08","2021-08-21","2022-02-05","2022-02-05","2021-08-01","2022-02-18","2021-08-06","2022-02-11","2022-02-16","2022-02-16","2021-06-24","2022-12-06","2022-09-12","2021-06-24","2021-06-24","2021-08-14","2022-02-07","2022-02-14","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-10-06","2022-02-02","2022-02-07","2022-02-03","2021-08-10","2021-08-10","2021-08-10","2022-02-08","2022-02-02","2021-08-22","2022-02-18","2022-02-01","2022-02-06","2022-02-06","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-01","2022-02-01","2022-05-12","2022-12-06","2022-05-12","2022-12-06","2022-02-01","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2022-11-08","2022-09-12","2022-09-15","2022-09-12","2022-09-12","2022-11-29","2022-08-30","2022-08-30","2022-10-06","2022-10-06","2022-12-06","2022-12-06","2022-11-16"],"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":[["","16729013716","CLONAZEPAM","TAB 1MG","62","Select","Select",""],["","16714087503","ATORVASTATIN","TAB 20MG","31","Select","Select",""],["","64380074208","BUSPIRONE","TAB 10MG","92","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","31","Select","Select",""],["","65862069299","PHENYTOIN","CAP 100MG","62","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","16714079501","TERBINAFINE","TAB 250MG","7","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0.5","Select","Select",""],["","59267030401","PFIZER","INJ BA4\/BA5","0.3","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","31","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","12","Select","Select",""],["","00904637861","CIPROFLOXACN","TAB 500MG","4","Select","Select",""],["","00121086750","VANCOMYCIN","CAP 125MG","8","Select","Select",""],["","00603548421","PROPRANOLOL","TAB 40MG","62","Select","Select",""],["","16714044402","ENALAPRIL","TAB 10MG","62","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","31","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","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":""}]}]}