{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ASSILEMRENTLITS A","gend":1,"add":" ELTTIL 0123DAOR RETARP","city":"GRUNDY","state":"VA","zip":"24614-6858","dob":"1978-04-08","age":"","mstatus":"","insh":"60019731","cliId":"","pno":"1367234762","cno":"","email":"","ename":"","eno":"","pphy":"PATEL, HARESH J","ppno":2769352148,"pcpadd":"1520 Slate Creek Rd Ste 102, ","pcpcity":"Grundy","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"TRI STATE CLINIC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"2718 Old Guesses Fork Rd","madd2":"","madd3":"","mcity":"Hurley","mstate":"VA","mzip":"24620-7973","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C91.10","D70.9","G40.89","Z45.2","D61.810","F11.20","C91.00","T45.1X5A","J44.9","E11.9","K21.9","G40.909","F31.9","F20.9","F43.10","Z86.718","Z90.710","Z90.49","D69.59","F17.210","D69.6","C95.90","R53.1","Z74.3","I87.2","M62.81","D84.9","R11.14","E86.0","R11.0","Z87.891","R11.2","R10.84","R00.0","R68.89","C91.01","I82.623","F11.11","F11.10","G89.29","R83.6","Z51.11","D61.818","R51","F41.9","D75.9","E87.0","E87.6","E83.42","G62.9","G47.00","Z91.5","I95.9","M54.5","M54.2","F60.3","Z85.41","Z79.899","C94.80","M54.9","R10.2","C92.40","G90.09","F41.1","D61.1","Z92.21","Z88.8","R42","J60","J96.01","J44.1","J44.0","I50.30","I48.20","N17.9","E87.1","J20.0","E11.65","I35.0","I34.0","R52","Z76.5","M79.606","M79.662","R53.81","C95.11","C91.Z0","M25.511","M25.512","R07.9","D53.9","R71.8","Z85.6","T45.1X5D","Z86.59","G89.18","M25.552","N39.0","R05","R50.9","R30.0","E86.9","R04.0","R63.3","Z72.89","R06.02","D72.819","F31.64","G43.909","R11.10","G43.009","R40.4","R26.89","R03.0","R19.7","B19.20","R07.89","B18.2","Z86.79","Z87.19","Z88.5","H83.09","J01.90","J32.9","M79.605","K82.8","R79.89","T80.211A","B95.2","B95.7","R16.2","Z11.59","Z13.6","R78.81","M79.18","K76.9","C95.10","K75.9","K59.00","Z95.828","M25.551","M51.37","M47.817","Z11.52","M79.661","Z20.822","I10","D64.9","J45.909","Z87.828","Z86.19","C91.02","G89.3","Z75.3","Y71.0","D49.9","R53.0","I36.1","Z04.9","D63.0","M79.10","D72.829","R53.83","R46.89","Z88.6","Z79.2","C92.00","R06.9","R10.9","E83.39","K86.89","Z80.9","G89.4","Z71.89","R00.2","C95.91","K92.0","M54.50","E04.2","D75.89","E78.5","R73.9","M54.31","Z51.12","Z51.81","R10.11","C80.1","C90.00","E78.00","R56.9","K92.1","R63.0","R21","Z53.20","R18.8","K59.09","R93.5","R14.0","K76.0","Z86.39","R10.33","R60.0","E80.6","K72.91","K52.9","G93.89","K72.90","R41.0","R41.82","R94.5","K83.8","F31.5","M79.604","M25.559","M79.669","F31.12","K76.6","T78.40XD","R91.8","K74.60","R10.30","R17","U07.1","K76.5","F17.290","Z51.5","R85.69","J90","I87.8","R16.1","R63.5","R18.0","G47.01","G93.40","K74.69","F31.81","E43","Z46.82","Z86.16","Z74.1","R26.81","J32.1","M51.17","L30.9","G43.109","G64","F34.1","J15.9","Z72.0","R16.0","D69.3","X58.XXXA","Y92.9","F15.10","F42.9","R73.03","S79.821A","I08.1","I37.1","S24.159A","M16.11","W20.8XXA","F17.200","F19.10","R10.12","E11.21","N93.9","K73.9","R89.8","R22.43","R09.89","J96.02","A41.4","R65.21","J18.9","B19.10","R04.2","K56.7","A04.72","H53.8","M89.9","F33.9","Z01.810","F31.89","R19.5","Z98.890","R50.81","J96.00","R09.02","J98.4","K31.89","R84.6","A41.9","Z99.11","K56.609","R59.0","K63.9","K63.89","I35.8","J96.90","R57.9","K59.39","D82.8","K59.8","J98.11","R94.31","Z03.89","K56.699","I82.621","F32.9","D89.9","C18.9","C22.0","Z43.3","Z79.4","C95.00","T82.897A","Z86.69","F17.213","I82.601","F17.203","D47.3","D59.1","Z79.01","J30.9","Z68.1","R63.6","C85.12","J30.89","F31.60","R45.1","R44.0","Z87.820","D75.82","D69.1","I82.403","D70.2","D53.8","D70.1","Y84.8","T80.219A","B96.89","E11.40","B37.0","R10.31","M79.601","M79.602","Z87.898","Z76.0","E44.0","E87.70","I82.423","F19.11","G40.509","D63.8","D70.8","D72.810","G40.802","E44.1","L03.115","B00.1","Z79.891","F11.90","I45.10","Z68.21","Z91.19","F39","F11.99","D64.81","I49.9","F31.30","R79.9","D69.49"],"date":["2020-09-16","2021-12-27","2020-09-16","2020-09-16","2021-07-22","2021-07-03","2022-03-24","2021-07-16","2022-03-08","2021-12-27","2021-07-26","2022-01-05","2022-03-24","2020-01-01","2020-01-01","2022-02-09","2020-03-04","2020-01-01","2022-02-26","2021-08-27","2022-03-15","2022-03-10","2022-01-04","2020-01-01","2020-08-21","2020-03-09","2022-01-13","2020-01-08","2021-04-22","2022-03-11","2022-03-24","2022-03-18","2022-03-11","2021-10-06","2020-07-01","2021-12-27","2020-03-04","2020-01-13","2021-12-29","2022-03-11","2020-01-24","2022-01-13","2021-09-24","2020-05-13","2022-03-24","2020-01-20","2020-01-22","2022-03-14","2020-05-25","2022-01-15","2021-07-09","2020-01-20","2021-08-01","2021-09-23","2020-05-27","2022-02-07","2022-01-05","2022-03-15","2020-01-25","2022-01-31","2022-01-04","2020-01-28","2021-02-15","2022-03-02","2020-01-31","2022-02-09","2022-03-14","2022-03-22","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2022-01-04","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2022-03-21","2021-10-06","2022-01-31","2021-03-28","2022-03-10","2020-05-25","2020-02-17","2020-02-16","2020-02-16","2020-07-21","2021-08-17","2020-03-04","2022-03-18","2020-03-04","2020-03-04","2020-03-04","2022-01-30","2020-08-21","2020-03-12","2021-07-22","2021-12-16","2020-04-16","2020-04-16","2020-04-26","2021-12-29","2022-01-05","2021-07-06","2022-02-07","2020-06-15","2022-01-31","2020-06-24","2020-06-24","2020-06-24","2022-03-11","2021-12-09","2020-07-08","2020-07-21","2022-03-15","2020-08-13","2020-07-22","2020-07-22","2020-08-09","2020-08-09","2020-08-09","2022-01-30","2020-08-27","2022-03-15","2020-08-24","2020-08-22","2020-08-22","2021-07-03","2020-08-22","2020-08-24","2020-08-24","2021-10-18","2022-03-08","2020-12-07","2020-09-30","2022-02-26","2021-06-17","2022-01-30","2021-03-28","2021-03-28","2021-03-28","2021-03-28","2022-01-31","2021-06-29","2021-08-09","2021-07-03","2021-07-03","2021-07-03","2022-03-22","2022-03-24","2021-07-08","2021-07-08","2021-07-09","2021-07-19","2021-07-13","2021-07-13","2021-07-19","2021-11-15","2021-07-27","2022-03-04","2021-07-31","2021-08-01","2021-08-01","2021-08-09","2021-08-11","2022-02-26","2021-08-27","2021-08-27","2022-01-05","2021-10-06","2022-03-18","2021-11-04","2021-10-06","2021-12-09","2022-03-02","2022-01-13","2021-11-03","2021-11-04","2021-11-04","2021-11-11","2021-12-16","2021-11-11","2021-11-15","2021-11-15","2021-12-16","2021-12-01","2021-12-01","2021-12-29","2022-01-13","2021-12-09","2021-12-25","2022-03-24","2022-01-13","2022-01-04","2022-03-08","2022-01-17","2022-01-05","2022-01-05","2022-01-06","2022-03-15","2022-01-17","2022-01-15","2022-01-15","2022-03-14","2022-01-15","2022-01-15","2022-03-14","2022-01-17","2022-01-18","2022-01-30","2022-01-30","2022-01-30","2022-02-09","2022-03-24","2022-03-04","2022-03-14","2022-03-10","2022-03-10","2022-03-10","2022-03-15","2022-03-14","2022-03-14","2022-03-24","2022-03-14","2022-03-14","2022-03-19","2022-03-15","2022-03-15","2022-03-18","2022-03-18","2022-03-18","2022-03-19","2022-03-21","2022-03-22","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2019-01-23","2019-02-21","2019-03-05","2019-05-15","2019-09-18","2019-04-11","2019-05-19","2019-11-08","2019-05-19","2019-12-27","2019-06-08","2019-06-08","2019-06-08","2019-12-27","2019-06-23","2019-06-08","2019-06-08","2019-06-08","2019-06-12","2019-06-12","2019-06-14","2019-09-03","2019-10-03","2019-06-20","2019-11-22","2019-09-10","2019-06-25","2019-06-26","2019-07-18","2019-07-18","2019-07-13","2019-06-29","2019-06-29","2019-07-22","2019-07-17","2019-11-15","2019-07-27","2019-07-27","2019-07-11","2019-07-02","2019-07-09","2019-06-29","2019-07-09","2019-07-05","2019-07-09","2019-10-22","2019-07-28","2019-07-13","2019-07-20","2019-07-12","2019-07-12","2019-10-20","2019-07-15","2019-07-13","2019-07-13","2019-07-13","2019-07-17","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-22","2019-07-19","2019-07-17","2019-12-20","2019-07-20","2019-07-25","2019-08-09","2019-12-19","2019-12-22","2019-08-02","2019-08-02","2019-08-02","2019-11-29","2019-11-29","2019-08-04","2019-12-04","2019-08-10","2019-08-10","2019-08-10","2019-10-11","2019-08-21","2019-09-16","2019-12-21","2019-11-12","2019-09-03","2019-09-04","2019-09-04","2019-12-19","2019-11-08","2019-09-04","2019-09-16","2019-09-20","2019-12-01","2019-10-02","2019-12-01","2019-10-11","2019-11-14","2019-10-14","2019-10-14","2019-10-14","2019-11-24","2019-10-20","2019-10-16","2019-10-16","2019-10-16","2019-11-07","2019-11-05","2019-11-15","2019-11-07","2019-11-08","2019-12-02","2019-11-08","2019-11-12","2019-11-08","2019-11-08","2019-11-12","2019-12-22","2019-12-01","2019-12-04","2019-12-02","2019-12-17","2019-12-17","2019-12-17","2019-12-19","2019-12-19","2019-12-19","2019-12-22","2019-12-20","2019-12-22","2019-12-27","2019-12-27"],"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":[["","00003052811","SPRYCEL","TAB 50MG","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","63","Select","Select",""],["","00603389032","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00228300311","CLONAZEPAM","TAB 0.5MG","15","Select","Select",""],["","49884030702","CLONAZEP","TAB 0.25MG","16","Select","Select",""],["","68382009705","PAROXETINE","TAB 10MG","30","Select","Select",""],["","68462022110","LITHIUM","CAP 300MG","60","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","47781026305","OXYCODONE","TAB 5MG","32","Select","Select",""],["","70710113001","CHLORPROMAZ","TAB 25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","8","Select","Select",""],["","00406324401","HYDROMORPHON","TAB 4MG","10","Select","Select",""],["","63020053330","ICLUSIG","TAB 30MG","30","Select","Select",""],["","42858086706","DRONABINOL","CAP 2.5MG","28","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","40","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","30","Select","Select",""],["","11845016459","WOMENS","TAB FORMULA","90","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","30.00","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30.00","Select","Select",""],["","46122001471","GNP","POW ","510","Select","Select",""],["","00378258601","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","50580044936","TYLENOL","TAB 500MG","100","Select","Select",""],["","00904078816","MILK","SUS 1200\/15","360","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","57237000930","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","00904675060","DOK","TAB 100MG","60","Select","Select",""],["","68462010430","FLUCONAZOLE","TAB 200MG","60","Select","Select",""],["","31722053812","LEVETIRACETA","TAB 750MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","31722077705","ACYCLOVIR","TAB 400MG","45","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","20","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","28","Select","Select",""],["","45802041059","NASAL","SPR 0.0005","30","Select","Select",""],["","00536641208","MELATONIN","TAB 3MG","30","Select","Select",""],["","00904552952","HEARTBURN","TAB RELIEF","120","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","946.00","Select","Select",""],["","00054014308","GRANISETRON","TAB 1MG","2","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","25","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","56","Select","Select",""],["","10702023701","URSODIOL","CAP 300MG","60","Select","Select",""],["","29300035005","ALLOPURINOL","TAB 300MG","14","Select","Select",""],["","00904672559","SENNA","TAB 8.6MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00904585692","CALCIUM","TAB 600MG","60","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","31722083330","ENTECAVIR","TAB 0.5MG","30","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0.5","Select","Select",""],["","00135019502","NICODERM","DIS 14MG\/24H","28","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","480","Select","Select",""],["","00143211250","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","00904676130","12HOUR","SPR 0.0005","30","Select","Select",""],["","00904641292","CALC","CHW 500MG","120","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","6.7","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00536104815","ANTACID","CHW 500MG","120","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","28","Select","Select",""],["","49884090761","MEGESTROL","SUS 40MG\/ML","600","Select","Select",""],["","51672411103","PHENYTOIN","CAP 100MG","120","Select","Select",""],["","00378100501","AZATHIOPRINE","TAB 50MG","30","Select","Select",""],["","24208072002","DEXAMETH","SOL 0.1% OP","5","Select","Select",""],["","00904000414","MI-ACID","SUS ","900","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","00591071805","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","00955100610","ENOXAPARIN","INJ 60\/0.6ML","16.8","Select","Select",""],["","69315090401","LORAZEPAM","TAB 0.5MG","9","Select","Select",""],["","57896040110","DOCUSATE","CAP 100MG","60","Select","Select",""],["","31722055190","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","24385040478","SENNA-LAX","TAB 8.6MG","60","Select","Select",""],["","54162055009","MEN-PHOR","LOT ","222","Select","Select",""],["","00904674880","BISACODYL","TAB 5MG EC","30","Select","Select",""],["","16500007410","ONE-A-DAY","TAB WOMENS","30","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":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}