{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SELRAHCSIRROM ","gend":0,"add":"PS REMLAPFLA SGNIR","city":"BOYDTON","state":"VA","zip":23917,"dob":"1958-03-21","age":"","mstatus":"","insh":"50014210","cliId":"","pno":"6843477035","cno":"","email":"","ename":"","eno":"","pphy":"WEIDMAN, PAUL DANIEL","ppno":4348653077,"pcpadd":"420 DURANT ST,","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"pcpcounty":"","pcpid":"","pcpname":"CMH PHYSICIAN SERVICES LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"PALMER SPRINGS ALF","add3":"","madd1":"PALMER SPRINGS ALF","madd2":"2450 MINERAL SPRINGS ROAD","madd3":"","mcity":"BOYDTON                       ","mstate":"VA","mzip":"23917-4404","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B18.2","E11.9","R39.81","E11.40","I10","E78.5","K75.9","Z79.4","Z79.899","E86.0","R56.9","R55","E10.40","N17.9","M62.82","G81.94","K21.9","E87.5","E11.42","N18.2","E11.22","I12.9","Z83.3","Z87.891","E86.9","K52.9","I95.9","S90.921A","W26.8XXA","E11.65","E78.00","Z23","I95.1","I69.354","E11.51","E11.649","Z11.59","Z86.19","R53.1","E16.2","I36.1","I65.23","B19.20","I95.89","G81.90","G81.92","R03.1","R53.83","R53.81","E11.36","H40.013","H25.12","Z01.818","H25.013"],"date":["2021-04-12","2021-11-02","2021-07-20","2021-10-21","2019-02-25","2019-07-23","2019-02-25","2020-10-13","2021-10-11","2020-06-25","2019-06-30","2020-06-24","2019-06-30","2020-06-25","2019-06-30","2020-10-13","2020-06-25","2020-06-23","2020-06-25","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2020-06-23","2019-07-01","2019-07-01","2020-06-25","2019-11-13","2019-11-13","2021-12-29","2019-12-04","2020-10-13","2020-06-23","2020-06-23","2021-10-21","2020-06-23","2020-06-23","2020-06-23","2020-06-25","2020-06-23","2020-06-24","2020-06-24","2020-06-25","2020-07-14","2020-10-13","2021-04-12","2021-04-12","2021-10-21","2021-10-21","2021-10-11","2021-11-02","2021-12-01","2021-12-29","2021-12-29"],"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":[["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","00065924007","DUREZOL","EMU 0.0005","5","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","69097095705","PREGABALIN","CAP 100MG","93","Select","Select",""],["","00378269501","AMITRIPTYLIN","TAB 150MG","31","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","31","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","31","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","31","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","31","Select","Select",""],["","46122061587","GNP","TAB 81MG EC","31","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","61314063710","PREDNISOLONE","SUS 1% OP","15","Select","Select",""],["","17478062312","SOD","SOL 5% OP","15","Select","Select",""],["","50804011001","ARTIFICIAL","SOL TEARS","15","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","16103035611","ASPIRIN","TAB 81MG EC","31","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","00169368712","LEVEMIR","INJ ","10","Select","Select",""],["","57896063412","MAG","TAB 400MG","5","Select","Select",""],["","00071101568","LYRICA","CAP 100MG","57","Select","Select",""],["","08290328431","INSULIN","MIS 0.3\/30G","100","Select","Select",""],["","00093010910","CARBAMAZEPIN","TAB 200MG","31","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}