{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"P R KCAJRJ REZTI","gend":0,"add":"          EVA TOPLIHP 812                         ","city":"RICHLANDS                ","state":"VA","zip":"24641-9998","dob":"1972-05-03","age":"","mstatus":"","insh":"10110636","cliId":"","pno":"6967213244","cno":"","email":"","ename":"","eno":"","pphy":"MORGAN, CLAYTON L","ppno":2765966780,"pcpadd":"6719 GOVERNOR GC PEERY HWY STE 2900,","pcpcity":"Richlands","pcpstate":"VA","pcpzip":246410317,"pcpcounty":"","pcpid":"","pcpname":"CLINCH PROFESSIONAL PHYSICIAN SERVICES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"218 PHILPOT AVE                                   ","madd2":"                                                  ","madd3":"","mcity":"RICHLANDS                ","mstate":"VA","mzip":"24641-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","J39.9","R06.02","G47.33","D72.829","I85.00","K76.0","E78.2","R63.5","K44.9","K21.00","R93.5","R19.7","K62.5","E10.9","E11.65","I10","E03.9","E88.81","Z79.4","Z99.89","Z76.0","Z13.31","K22.8","Z00.00","Z13.89","Z68.43","E78.5","K21.9","F31.9","E66.01","F20.9","R53.83","E55.9","R60.9","N28.1","Z87.891","R73.9","E66.9","K20.90","K29.70","K22.70","Z23","Z12.5","E83.42","R16.0","I85.10","F10.10","Z71.89"," ","E10.42","L03.032","M76.62","M79.672","M79.675"],"date":["2022-09-19","2021-03-01","2021-03-11","2022-11-29","2022-08-08","2022-03-11","2022-09-30","2022-09-19","2022-03-11","2022-03-11","2022-03-28","2022-03-16","2022-03-11","2022-09-30","2021-07-14","2022-11-14","2022-09-19","2022-11-14","2022-09-19","2022-08-08","2022-03-28","2022-01-26","2022-01-26","2021-07-14","2021-09-07","2021-09-07","2022-07-19","2022-07-19","2022-09-30","2021-03-22","2022-09-19","2021-05-27","2022-03-28","2022-03-28","2021-03-11","2022-01-24","2022-04-21","2022-03-28","2021-07-19","2021-07-14","2021-07-14","2021-07-14","2022-03-28","2022-09-19","2021-05-27","2021-10-14","2022-09-30","2022-09-30","2022-10-02","2022-11-29","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","00378180710","LEVOTHYROXIN","TAB 88MCG","90","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","30","Select","Select",""],["","69238115409","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","00002318280","TRULICITY","INJ 4.5\/0.5","6","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","180","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","99073012101","FREESTYLE    TES","TES ","100","Select","Select",""],["","00169255013","TRESIBA","INJ 200UNIT","81","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","65162057110","BETHANECHOL","TAB 5MG","90","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","45","Select","Select",""],["","00378632577","VALSART\/HCTZ","TAB 320-25MG","90","Select","Select",""],["","43547034106","RISPERIDONE","TAB 1MG","270","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","180","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","180","Select","Select",""],["","68180023209","FENOFIBRATE","TAB 160MG","90","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","400","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","360","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0.5","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","300","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","300","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}