{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NAIVIVLLIH C","gend":1,"add":"     DAOR DROFDEB   11411                         ","city":"COEBURN                  ","state":"VA","zip":"24230-6523","dob":"1962-07-11","age":"","mstatus":"","insh":"10115052","cliId":"","pno":"0267286682","cno":"","email":"","ename":"","eno":"","pphy":"RENFRO, THOMAS E","ppno":2763952389,"pcpadd":"HWY 58 MARTY SHOPPING CENTER,  ","pcpcity":"COEBURN","pcpstate":"VA","pcpzip":242300000,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY PHYSICIANS COEBURN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"11411   BEDFORD ROAD                              ","madd2":"                                                  ","madd3":"","mcity":"COEBURN                  ","mstate":"VA","mzip":"24230-6523","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.9","J45.31","J06.9","J44.1","F41.1","Z79.899","J45.21","R11.0","R10.9","M54.17","M54.5","M79.651","M79.604","F17.210","J44.9","E03.9","M79.7","E78.5","B34.9","Z20.822","F17.290","S52.515A","R10.30","F41.9","R07.9","R29.6","R26.89","R25.1","M25.551","M79.672","M54.42","F17.200","K57.90","M25.552","M54.41","G89.29","M19.072","K21.9","Z79.51","E66.09","F33.1","Z68.34","R10.84","K57.30","Z86.010","F33.2","F51.05","R45.851","R07.81","R10.31","R10.11","W18.2XXA","M51.26","S32.9XXA","M48.062","D12.2","D12.8","S52.125A","S49.92XA","W19.XXXA","M25.559","M54.16","S52.592A","M25.572","S99.922A","R20.2","R20.0","K62.1","R73.9","R39.81","R15.9","N39.45","T65.92XA","T65.91XA","F19.10","G89.4","Z23","H16.223","S93.402A","W17.89XA","Y93.9","Y92.9","Z72.0","S52.515D","M53.3","M47.816","M46.96","M51.16","M51.17","Z04.3","Y93.E9","Y92.012","M16.11","R11.2","M54.9","J45.909","Z00.00","Z12.31","M51.36","R91.8","Z13.39","H65.93","L29.9","R11.10","R52","R60.9","W01.0XXA","W18.39XA","M48.061"],"date":["2022-01-18","2021-11-17","2022-03-15","2022-06-30","2022-06-30","2022-03-15","2022-03-15","2022-01-22","2022-01-22","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2022-01-22","2022-01-22","2022-06-30","2021-02-10","2022-01-22","2022-01-18","2022-01-26","2022-01-31","2021-09-10","2022-01-22","2021-11-17","2020-05-28","2020-08-13","2020-08-13","2020-08-13","2021-02-03","2020-08-13","2022-06-30","2020-08-13","2022-06-19","2020-08-13","2022-06-30","2022-06-30","2020-09-10","2022-01-22","2022-01-22","2021-02-03","2021-08-04","2021-02-03","2020-09-08","2020-10-16","2020-10-16","2022-02-21","2022-02-21","2022-02-21","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2021-07-13","2021-02-11","2021-07-13","2020-10-16","2020-10-16","2021-07-20","2021-07-20","2021-07-20","2022-02-09","2022-02-09","2021-07-20","2020-07-07","2020-07-07","2021-10-07","2021-10-07","2020-10-16","2021-11-04","2022-06-19","2022-06-19","2022-06-19","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2021-11-04","2020-03-16","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2021-08-06","2021-11-04","2021-11-04","2021-02-11","2021-02-11","2021-02-11","2020-05-28","2020-05-28","2020-05-28","2021-08-16","2020-08-05","2020-08-05","2020-08-05","2022-03-15","2021-08-04","2021-10-01","2022-01-26","2022-01-26","2020-05-27","2020-05-27","2022-01-18","2022-01-18","2020-09-10","2021-07-20","2020-07-07","2021-02-25"],"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":[["","68382009905","PAROXETINE","TAB 30MG","30","Select","Select",""],["","16729031701","OXYBUTYNIN","TAB 5MG ER","5","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00228202796","ALPRAZOLAM","TAB 0.25MG","60","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","24","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","7","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","180","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10.2","Select","Select",""],["","63304073530","ESOMEPRA","CAP 40MG DR","90","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","7","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","68462026290","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","20","Select","Select",""],["","00378875006","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","47781010444","ESTRADIOL","CRE 0.0001","42.5","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","68462018905","NAPROXEN","TAB 375MG","14","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","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":""}]}]}