{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R   HTIDETREBMAL ","gend":1,"add":"OB OP295 X","city":"CHASE CITY","state":"VA","zip":"23924-0592","dob":"1959-01-29","age":"","mstatus":"","insh":"40010349","cliId":"","pno":"6243413382","cno":"","email":"","ename":"","eno":"","pphy":"HASENMUELLER, KIRK R","ppno":4344477375,"pcpadd":"140 E Ferrell St, ","pcpcity":"South Hill","pcpstate":"VA","pcpzip":239702102,"pcpcounty":"","pcpid":"","pcpname":"CMH PHYSICIAN SERVICES LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 592","madd2":"","madd3":"","mcity":"CHASE CITY","mstate":"VA","mzip":"23924-0592","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","I10","E78.5","M19.90","K85.90","F17.210","F12.10","R68.89","Z00.00","M12.9","F31.32","F34.81","F31.81","J45.909","S99.912A","M79.89","R93.6","S82.55XA","E66.3","Z68.28","S92.155A","S93.402A","S92.155D","S93.402D","S82.55XD","J44.1","R06.02","R04.2","R05","J44.0","J20.9","E87.2","E86.0","J45.20","E87.6","E83.39","R51","I50.9","K29.70","R07.89","I11.0","G44.209","J44.9","Z79.84","M06.9","F12.90","R09.82","Z87.891","Z87.09","M84.472A","M25.572","R60.0","R26.2","M62.81","F31.9","F41.1","Z11.59","M79.602","X12.XXXA","R53.1","T22.212A","T24.202A","T24.201A","X10.2XXA","T24.301A","T24.302A","T22.30XA","T31.0","X00.0XXA","T24.331A","W18.30XA","Y93.G3","I50.32","T23.362A","T24.332A","Z23","Z20.828","E55.9","Z13.83","T22.20XA","T22.00XA","T24.001A","T24.002A","T31.60","Z48.01","T23.332A","T22.312A","S71.102A","G89.18","M79.604","R06.1","T23.202A","T24.231A","T81.89XA","Z48.817","T24.331D","T24.332D","T23.362D","T22.212D","T22.232D","X10.2XXD","L91.0","L90.5","Z72.89","Z74.09","E66.9","D64.9","T24.031D","T24.032D","T22.032D","F12.980","K86.89","R53.83","F31.76","L81.9","M79.2","E78.2","J30.2","Z87.19","Z12.31","R92.8","M79.7","R10.12","R19.7","Z79.899","Z00.8","Z13.220","R63.4","K31.89","K63.9","D12.4","K52.9","K57.30","K64.9","M54.5","G89.29","K63.5"],"date":["2020-01-13","2022-02-24","2020-01-13","2020-01-13","2020-01-13","2020-07-15","2020-01-13","2021-02-26","2020-01-13","2020-01-13","2021-02-19","2020-01-23","2021-05-11","2021-02-04","2020-06-11","2020-06-11","2020-06-11","2020-06-16","2020-07-07","2020-06-16","2020-06-16","2020-06-16","2020-08-18","2020-08-18","2020-07-07","2020-07-14","2020-07-12","2020-07-12","2020-07-12","2020-07-14","2020-07-13","2020-07-13","2020-07-14","2020-07-14","2021-02-04","2020-07-14","2020-07-12","2020-07-14","2020-07-14","2020-07-13","2020-11-14","2020-07-14","2021-01-04","2020-08-03","2020-08-03","2020-11-14","2020-08-21","2022-02-24","2020-08-21","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2021-06-02","2020-10-06","2020-10-16","2020-11-26","2020-11-14","2020-11-14","2020-12-17","2020-11-25","2020-11-25","2020-11-30","2020-11-19","2020-11-19","2020-11-25","2021-01-04","2020-11-14","2020-11-25","2020-11-14","2020-11-14","2021-01-04","2020-11-25","2020-11-25","2020-11-14","2020-11-14","2021-08-04","2020-11-14","2020-11-15","2020-11-30","2020-11-30","2020-11-30","2020-11-19","2020-11-19","2020-11-25","2020-11-25","2020-11-25","2020-11-26","2020-11-26","2020-11-26","2020-12-17","2020-12-17","2020-12-17","2020-12-11","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-12-27","2021-06-21","2021-01-04","2021-01-04","2021-01-04","2021-02-04","2021-06-21","2021-06-21","2021-06-21","2021-10-20","2021-08-04","2021-08-04","2022-01-19","2021-12-27","2021-12-27","2022-02-24","2022-02-24","2022-02-24","2019-02-22","2019-03-26","2019-08-23","2019-08-23","2019-08-23","2019-08-23","2019-08-09","2019-08-09","2019-08-23","2019-08-23","2019-08-23","2019-08-23","2019-08-23","2019-08-23","2019-08-23","2019-08-23","2019-08-23","2019-08-23"],"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":{"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":[["","51991029301","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","31604002675","D3","CAP 1000UNIT","30","Select","Select",""],["","00603221621","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","30","Select","Select",""],["","40985027415","D3-1000","CAP 1000UNIT","30","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","65862020390","LOSARTAN","TAB 100MG","30","Select","Select",""],["","00228212810","CLONIDINE","TAB 0.2MG","30","Select","Select",""],["","59779001951","ALLERGY","CAP 25MG","60","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","180","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00536106210","STOOL","CAP 100MG","20","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","31604001870","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","23155000201","HYDRALAZINE","TAB 25MG","90","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","10","Select","Select",""],["","50428015144","CVS","CAP 1000UNIT","30","Select","Select",""],["","65862049001","QUETIAPINE","TAB 50MG","30.00","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","30","Select","Select",""],["","00032301613","CREON","CAP 36000UNT","200","Select","Select",""],["","69842000003","FLUTICASONE","SPR 50MCG","9.9","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0.5","Select","Select",""],["","00005197102","PREVNAR","INJ ","0.5","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0.5","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","24","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","45802002146","BETAMETH","LOT 0.0005","60","Select","Select",""],["","43199001401","HYOSCYAMINE","TAB 0.375 ER","60","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00536110888","NICOTINE","DIS 21MG\/24H","24","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0.5","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","00406996001","TEMAZEPAM","CAP 7.5MG","30","Select","Select",""],["","50428027684","MELATONIN","TAB 5MG","60","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","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":""}]}]}