{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALLEDEZXOC V ","gend":1,"add":"ZAY71301DAOR OO","city":"WISE","state":"VA","zip":"24293-5860","dob":"1978-10-10","age":"","mstatus":"","insh":"50017169","cliId":"","pno":"5267230230","cno":3093315940,"email":"","ename":"","eno":"","pphy":"WHEATLEY, MICHAEL W","ppno":2763287071,"pcpadd":"417 W MAIN ST,","pcpcity":"Wise","pcpstate":"VA","pcpzip":"24293-6904","pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"10317YAZOO ROAD","add3":"","madd1":"10317YAZOO ROAD","madd2":"","madd3":"","mcity":"WISE","mstate":"VA","mzip":"24293-5860","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F15.11","F17.210","F12.11","F13.10","R68.89","D50.9","Z13.9","D68.9","L53.9","X58.XXXA","S40.012A","I10","F32.9","I25.2","Z86.718","Z79.899","K21.9","I82.A22","F33.9","N63.15","G89.29","R07.9","Z74.3","R79.1","F13.11","N63.20","Z12.31","I82.723","I82.5Y3","I26.99","T83.511D","N31.9","N39.0","R33.9","Q05.9","R39.9","L30.4","G47.09","R10.9","N83.9","N19","T83.192A","Y83.8","D68.62","J44.1","I16.0","I11.0","I50.9","I27.20","G62.9","M41.9","Z46.6","I82.409","F41.1","R06.2","R09.02","Z96.0","Z87.891","J44.9","R73.03","M54.5","Z87.440","F41.9","K22.2","R07.89","F15.10","F12.10","F14.11","R61","F11.10","B18.2","N18.31","D63.1","R19.5","R13.19","K92.1","Z01.818","Z20.822","K31.89","Z80.0","K29.70","K59.00","K44.9","Z86.711","R74.8","K59.04","M47.814","M54.59","M54.9","M46.1","Z98.1","Z86.69","N32.81","Z53.21","R30.0","Z72.0","G56.02","F15.20","N18.30","N63.10","N64.2","R10.13","K43.9"],"date":["2023-05-18","2021-12-13","2023-05-18","2021-12-13","2023-05-18","2021-02-25","2022-03-07","2022-05-16","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2022-08-31","2021-01-26","2022-03-07","2022-03-07","2021-01-26","2022-03-07","2021-01-26","2021-06-25","2021-02-22","2022-05-16","2023-05-29","2021-01-26","2021-01-26","2022-12-19","2021-02-22","2021-02-22","2022-07-25","2022-07-25","2022-07-25","2021-02-25","2023-05-17","2023-05-18","2023-05-17","2023-05-17","2022-08-31","2021-05-14","2021-06-25","2022-08-06","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-28","2021-05-28","2022-03-07","2021-08-19","2021-05-28","2021-05-27","2022-05-27","2021-05-28","2021-05-28","2021-05-28","2021-05-29","2021-05-28","2021-05-29","2021-05-29","2021-06-25","2021-06-17","2021-06-24","2021-06-24","2021-06-25","2021-06-25","2021-08-06","2022-12-19","2023-05-18","2023-05-18","2023-05-18","2022-02-15","2022-05-16","2022-02-15","2022-02-15","2022-03-07","2022-05-16","2022-03-07","2022-03-03","2022-03-03","2022-03-07","2022-03-07","2022-03-07","2022-03-07","2022-03-07","2022-07-25","2022-05-16","2022-05-16","2022-05-27","2022-05-27","2022-05-27","2022-05-27","2022-05-27","2022-05-27","2023-05-18","2022-08-06","2022-08-06","2022-08-06","2022-08-31","2023-05-18","2023-02-27","2023-03-07","2023-03-07","2023-05-29","2023-05-29"],"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":[["","00054001829","PREDNISONE","TAB 20MG","6","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","51991029305","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","90","Select","Select",""],["","51862094701","NORTRIPTYLIN","CAP 50MG","60","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","90","Select","Select",""],["","72578009001","TRIAMT\/HCTZ","CAP 37.5-25","30","Select","Select",""],["","60505392801","GUANFACINE","TAB 2MG ER","30","Select","Select",""],["","13668033205","TRAZODONE","TAB 150MG","60","Select","Select",""],["","68180044701","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00955101510","ENOXAPARIN","INJ 150MG\/ML","30","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","135","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","14","Select","Select",""],["","12496120801","SUBOXONE","MIS 8-2MG","56","Select","Select",""],["","52817018210","CLONIDINE","TAB 0.3MG","60","Select","Select",""],["","29300013005","HYDROCHLOROT","CAP 12.5MG","60","Select","Select",""],["","42858060203","BUPREN\/NALOX","SUB 8-2MG","28","Select","Select",""],["","31722070210","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","16729022517","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","55111068305","IBU","TAB 600MG","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0.25","Select","Select",""],["","67405060203","FLUCONAZOLE","TAB 100MG","2","Select","Select",""],["","00096070735","DRYSOL","SOL 0.2","35","Select","Select",""],["","45802005911","NYSTATIN","CRE 100000","30","Select","Select",""],["","69547035302","NARCAN","SPR","2","Select","Select",""],["","16729031816","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0.5","Select","Select",""],["","65862085999","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00781183120","AMOX\/K CLAV","TAB 500-125","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","00904792760","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","14","Select","Select",""],["","00472110556","BACITR ZINC","OIN 500\/GM","28","Select","Select",""],["","45802006001","BACITRACIN","OIN 500\/GM","28","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","30","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00000000000",""," ","240","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":""}]}]}