{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YERFFEJGGARG L","gend":0,"add":"RUOC 92EVIRD T","city":"Bristol","state":"VA","zip":"24201-9998","dob":"1970-02-05","age":"","mstatus":"","insh":"00112398","cliId":"","pno":"9467289104","cno":"","email":"","ename":"","eno":"","pphy":"SHIPLEY, JAMES M","ppno":4345427440,"pcpadd":"1497 W ELK AVE STE 20,","pcpcity":"Elizabethton","pcpstate":"TN","pcpzip":"37643-2896","pcpcounty":"","pcpid":"","pcpname":"MSMG IM ELIZ","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"29 COURT DRIVE","madd2":"","madd3":"","mcity":"Bristol","mstate":"VA","mzip":"24201-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.3","F43.21","F79","G56.41","G89.4","Z87.81","B20","G63","R10.84","R16.1","R51.9","I26.99","R56.9","I82.401","V87.7XXA","Z68.23","Z79.01","M54.5","M54.2","R52","Z87.828","M62.81","F11.20","Z51.81","Z79.891","Z79.899","I10","R05","N52.9","F17.210","R30.0","Z20.2","Z20.822","N45.1","D48.5","L91.8","R20.8","M51.36","M50.30","M47.816","G40.901","F41.1","M10.9","N40.0","S09.90XA","S22.000A","S16.1XXA","Z21","R10.9","J18.9","J02.0","J02.9","R05.9","K04.7","F33.1","R09.89","J40","R07.81","R19.09","M53.3","R60.9","C90.00","M54.50","R11.0","R19.7","K21.9","F43.12","G62.9","Z72.0","F20.9","F03.90","G40.909","Z97.3","Z86.711","R26.9","J44.1","R06.02","R07.9","E78.2","R79.1","M79.604","G89.21","D72.829","G56.40","Z71.6","G40.309","E78.5","I82.409","H60.501","Z11.52","Z16.33","N48.1","F41.9","L02.02","S29.9XXA","V89.2XXA","S39.91XA","M19.041","F43.10","I25.2","Z68.31","R35.0","S19.9XXA","Z11.3","G89.18","S82.191A","S80.01XA","C44.311","Z86.718","R41.82","J20.8","R05.8","A64","R23.3","R53.1","F33.0","M19.90","I73.9","N40.1","Z68.21","I87.001","N39.0","C44.319","B37.0","R10.30","M54.9","M25.522","M25.551","W19.XXXA","M25.572","S82.892A","S82.92XA","R07.2","M79.672","S92.031A","W10.8XXA"],"date":["2020-07-09","2020-07-09","2020-07-09","2020-07-29","2020-12-14","2020-07-29","2023-07-13","2020-07-29","2021-05-18","2021-05-18","2021-05-18","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2023-06-03","2021-09-09","2023-02-14","2021-09-09","2021-08-23","2021-08-23","2023-01-17","2023-07-13","2023-01-17","2023-01-17","2023-07-13","2020-04-02","2023-02-14","2023-02-14","2023-01-17","2022-10-23","2022-11-07","2022-07-14","2022-07-13","2022-07-13","2022-07-13","2023-07-13","2023-07-13","2020-01-08","2021-10-28","2023-07-13","2023-07-13","2023-02-14","2021-01-24","2021-01-24","2021-03-09","2022-09-06","2021-11-21","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2020-10-20","2023-07-13","2021-10-11","2021-10-11","2021-10-11","2021-05-19","2019-11-14","2022-06-29","2022-06-29","2023-05-17","2021-11-21","2021-11-21","2021-11-21","2023-07-13","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2021-05-18","2020-12-14","2021-04-28","2020-12-14","2021-11-11","2021-11-12","2023-06-03","2023-07-13","2022-03-08","2019-10-29","2023-07-13","2020-03-10","2020-06-08","2021-09-09","2020-06-08","2021-09-09","2019-12-27","2020-01-25","2021-10-11","2023-02-28","2019-11-22","2020-02-19","2021-05-15","2021-01-24","2021-03-09","2021-01-24","2021-03-02","2021-02-25","2021-10-28","2019-10-28","2022-08-12","2021-01-24","2023-07-13","2022-10-20","2022-01-04","2022-01-04","2022-10-04","2021-11-11","2021-05-18","2021-11-16","2021-11-16","2023-01-22","2021-05-18","2021-05-18","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2019-10-29","2022-10-23","2023-05-26","2020-03-03","2023-01-22","2023-05-17","2023-05-17","2023-05-17","2023-06-03","2023-06-03","2023-06-03","2023-06-03","2023-06-03","2023-06-03","2023-06-05","2023-05-17"],"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":[["","00093321205","CLONAZEPAM","TAB 1MG","90","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","71930006315","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","49702024213","JULUCA","TAB 50-25MG","30","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","30","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","20","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","30","Select","Select",""],["","24510017460","NUCYNTA ER","TAB 150MG","60","Select","Select",""],["","59676057530","PREZCOBIX","TAB 800-150","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","18","Select","Select",""],["","43547033950","RISPERIDONE","TAB 0.25MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","00378623201","CITALOPRAM","TAB 20MG","90","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","20","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","29300046810","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","65862076990","FENOFIBRATE","TAB 145MG","30","Select","Select",""],["","50383002505","OFLOXACIN","DRO 0.3%OTIC","5","Select","Select",""],["","33332032001","AFLURIA QUAD","INJ 2020-21","0.5","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0.3","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","68382079101","ACYCLOVIR","TAB 400MG","21","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","20","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","180","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","10","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","24208055555","BACIT\/POLYMY","OIN OP","3.5","Select","Select",""],["","24510017460","NUCYNTA","TAB 150MG","60","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0.5","Select","Select",""],["","59267102501","PFIZER","INJ ADLT RTU","0.3","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00093321205","CLONAZEPAM TAB","1MG","90","Select","Select",""],["","68462012605","GABAPENTIN TAB","600MG","90","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","49702024213","JULUCA TAB","50-25MG","30","Select","Select",""],["","49702022813","TIVICAY TAB","50MG","30","Select","Select",""],["","00527133001","BACLOFEN TAB","10MG","20","Select","Select",""],["","68382013201","TAMSULOSIN CAP","0.4MG","90","Select","Select",""],["","51672403201","WARFARIN TAB","5MG","30","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP TAB","7.5-325","18","Select","Select",""],["","59676057530","PREZCOBIX TAB","800-150","30","Select","Select",""],["","10702000350","PROMETHAZINE TAB","25MG","60","Select","Select",""],["","00378623201","CITALOPRAM TAB","20MG","90","Select","Select",""],["","71930006315","LEVETIRACETA TAB","500MG","60","Select","Select",""],["","00093317431","ALBUTEROL SULFATE","","8.5","Select","Select",""],["","00173071920","FLOVENT HFA AER","110MCG","12","Select","Select",""],["","65862017760","CEFDINIR CAP","300MG","20","Select","Select",""],["","70954005930","PREDNISONE PAK","10MG","21","Select","Select",""],["","67877021560","CEFUROXIME TAB","250MG","20","Select","Select",""],["","00591544210","PREDNISONE TAB","10MG","20","Select","Select",""],["","29300046810","CLONIDINE TAB","0.1MG","90","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","200","Select","Select",""],["","16729013401","ALLOPURINOL TAB","100MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","20","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","6.7","Select","Select",""],["","65862076990","FENOFIBRATE TAB","145MG","30","Select","Select",""],["","69547035302","NARCAN SPR","","2","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","14","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0.3","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","65862018601","CLINDAMYCIN CAP","300MG","30","Select","Select",""],["","68382079101","ACYCLOVIR TAB","400MG","21","Select","Select",""],["","55111012305","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","00527169505","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","00093224001","CEPHALEXIN TAB","500MG","10","Select","Select",""],["","24208055555","BACIT\/POLYMY OIN OP","","3.5","Select","Select",""],["","57237002801","AMOXICILLIN TAB","500MG","20","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","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":[]}},{"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":""}]}]}