{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C YLLEKCITSOB ","gend":1,"add":"YTNUOC 412DAOR ENIL ","city":"CEDAR BLUFF","state":"VA","zip":24609,"dob":"1979-11-25","age":"","mstatus":"","insh":"8667564","cliId":"","pno":"0767211691","cno":"","email":"","ename":"","eno":"","pphy":"MITCHELL, LARRY G","ppno":2767019611,"pcpadd":"ONE CLINIC DR CLAYPOOL HILL,","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":24641,"pcpcounty":"","pcpid":"","pcpname":"CLINCH VALLEY PHYSICIANS ASSOC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"214 COUNTY LINE ROAD","add3":"","madd1":"214 COUNTY LINE ROAD","madd2":"","madd3":"","mcity":"CEDAR BLUFF                   ","mstate":"VA","mzip":"24609-9589","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.118","R06.02","R07.9","I25.10","I25.119","Z95.1","E78.2","I11.9","Z72.0","Z12.31","J40","M54.16","E11.9","F31.32","I10","I20.0","I20.8","I25.110","R59.1","R11.2","G47.33","F17.210","K21.9","E66.9","Z68.28","Z11.59","Z79.4","Z88.0","Z88.1","Z01.810","R94.31","H10.30","R07.89","M48.061","M51.16","E11.65","F32.9","R19.7","R10.11","R59.0","R07.0","K76.0","M47.816","M54.5","Z79.84","H35.363","H16.223","H40.053","Q14.1","F17.208","R03.0","R14.0","G62.9","R55","R11.0","R00.2","R42","R51.9","R53.1","I95.9","R60.0","I70.0","E11.42","I25.810","Z79.899","R79.89","D72.829","Z71.6","Z13.6","R10.13","Z87.19","R10.84","R80.9","F17.200","R11.10","I51.89","M25.512","H66.006","E11.43","K31.84","H40.023","R30.0","R22.2","E78.1","J30.2","M25.561","S63.502A","M25.532","E11.40","E78.6"],"date":["2020-01-27","2020-04-21","2021-02-23","2021-10-01","2020-06-03","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-09-30","2020-02-06","2022-03-08","2021-10-04","2020-04-02","2022-02-03","2020-04-02","2020-04-02","2020-05-28","2020-04-02","2021-03-17","2022-02-03","2021-02-25","2021-06-09","2020-05-28","2020-05-28","2020-05-28","2021-10-04","2021-02-23","2020-05-28","2020-05-28","2021-02-23","2020-07-09","2021-10-01","2020-08-06","2020-08-06","2022-03-08","2020-08-11","2021-02-03","2020-09-14","2020-09-14","2020-09-14","2021-04-08","2020-09-15","2020-09-15","2021-10-04","2020-10-28","2021-10-04","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2021-02-03","2021-02-23","2021-02-23","2021-06-09","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-10-01","2021-02-23","2021-02-23","2021-02-23","2021-03-23","2021-02-23","2021-03-17","2021-03-31","2021-03-17","2021-03-17","2021-04-19","2021-03-23","2021-03-31","2021-04-08","2021-04-08","2021-05-10","2021-05-27","2021-08-03","2021-06-09","2021-10-04","2021-11-03","2022-03-03","2021-11-03","2021-12-06","2022-03-22","2019-08-12","2019-08-12","2019-12-03","2019-12-18"],"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":[["","53746019001","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00054050823","ICOSAPENT","CAP 1GM","120","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","00169413602","OZEMPIC","INJ 2\/1.5ML","3","Select","Select",""],["","00536331310","ASPIRIN","TAB 325MG EC","30","Select","Select",""],["","55111015930","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","60","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","43547035210","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","69097089915","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","33342006310","VALSARTAN","TAB 80MG","30","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","55111032001","GLIMEPIRIDE","TAB 1MG","30","Select","Select",""],["","00536137223","NICOTINE","GUM 4MG MINT","110","Select","Select",""],["","00781556031","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","04142000007","FLORASTOR","CAP 250MG","50","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","120","Select","Select",""],["","67877049030","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","00310621030","FARXIGA","TAB 10MG","30","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00591530710","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","42","Select","Select",""],["","00781196260","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","52817032000","BACLOFEN","TAB 10MG","21","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","20","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","60505317007","OMEGA-3-ACID","CAP 1GM","120","Select","Select",""],["","00065427325","PAZEO","DRO 0.007","2.5","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","61971012005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","62175012837","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","00093738201","VENLAFAXINE","TAB 75MG","30","Select","Select",""],["","27241009990","DULOXETINE","CAP 60MG","30","Select","Select",""],["","43598050930","ESOMEPRA","CAP 20MG DR","28","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","08496310601","EASY","MIS 31GX5\/16","100","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","59762306001","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","30","Select","Select",""],["","60505058401","EPINASTINE","DRO 0.0005","5","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00169185275","NOVOFINE","MIS 30GX8MM","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","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":""}]}]}