{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EGROEGSTTOL W","gend":0,"add":"      DR LLIH ECANRUF 201                         ","city":"GOSHEN                   ","state":"VA","zip":"24439-9998","dob":"1956-04-14","age":"","mstatus":"","insh":"10116397","cliId":"","pno":"3804547300","cno":"","email":"","ename":"","eno":"","pphy":"REXRODE, KIMBERLY R","ppno":5408397197,"pcpadd":"106 PARK DR,","pcpcity":"Hot Springs","pcpstate":"VA","pcpzip":244452921,"pcpcounty":"","pcpid":"","pcpname":"BATH COUNTY COMMUNITY HOSPITAL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"102 FURNACE HILL RD                               ","madd2":"                                                  ","madd3":"","mcity":"GOSHEN                   ","mstate":"VA","mzip":"24439-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R97.20","I10","E78.2","J44.9","F41.9","R73.01","M25.50","G62.9","I11.0","I50.22","I42.0","I44.7","E78.5","K21.9","G47.30","Z86.73","Z86.19","Z87.891","Z79.82","Z79.899","Z20.822","I42.8","Z45.2","Z45.02","I50.9","F41.1","M06.9","M15.9","Z51.81","M79.602","R06.09","I95.9","Z95.810","G47.33","Z12.5","Z00.00","M25.512","H91.93","E66.9","Z68.30","G60.9","M12.872","R20.8","R20.2","N18.30","H90.3","H93.13","M13.80","R94.2","M79.672","S06.0X9A","V49.40XD","M62.838","M79.18","M54.2","F07.81","V89.2XXD","R07.81","V89.2XXA","M99.61","M48.02","M79.10","M79.641","M25.519","V43.51XA","Y93.89","Y92.488","G89.11","M19.072","M89.312","L23.7"," ","M54.12","M54.50","Z74.09","M50.323","R42","F41.8","Z23"],"date":["2022-03-10","2022-10-13","2022-10-13","2022-11-21","2021-04-01","2022-04-05","2021-04-01","2022-10-13","2021-06-03","2021-12-13","2022-11-21","2021-12-13","2022-11-17","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2022-11-21","2021-04-20","2021-04-19","2021-04-19","2021-04-19","2021-04-21","2022-11-21","2022-11-21","2021-06-03","2021-06-03","2021-12-17","2021-12-17","2021-07-01","2022-05-20","2022-11-17","2022-04-05","2022-11-21","2022-10-13","2022-10-13","2022-11-02","2021-10-05","2021-10-05","2021-10-05","2022-08-08","2022-08-08","2022-02-09","2022-02-09","2021-11-23","2021-12-01","2021-12-01","2021-12-03","2022-03-01","2022-08-08","2022-03-08","2022-03-08","2022-12-05","2022-03-22","2022-12-05","2022-03-22","2022-08-17","2022-05-05","2022-05-03","2022-05-05","2022-05-05","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-08-08","2022-08-12","2022-09-06","2022-12-05","2022-12-05","2022-12-05","2022-11-02","2022-11-17","2022-11-17","2022-10-13","2022-10-13"],"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":[["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","14","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","90","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","180","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","180","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","90","Select","Select",""],["","00832054011","BUMETANIDE","TAB 0.5MG","90","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","54","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","0.7","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30.00","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","180","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","24","Select","Select",""],["","80777028299","MODERNA","INJ BA4\/BA5","0.5","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","28","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":""}]}]}