{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JERRY   D WEAVER JR","gend":0,"add":"3607 SIX MILE POST ROAD","city":"CALLAWAY","state":"VA","zip":"24067-4637","dob":"1983-02-16","age":"","mstatus":"","insh":4683707,"cliId":"","pno":5402431994,"cno":"","email":"","ename":"","eno":"","pphy":"UNWIN, BRIAN K","ppno":5409817000,"pcpadd":"1906 BELLEVIEW AVENUE, ","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"","pcpname":"NURSING HOME FRANKLIN HEALTH AND REHAB","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"3607 SIX MILE POST ROAD","madd2":"","madd3":"","mcity":"CALLAWAY","mstate":"VA","mzip":"24067-4637","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K63.1","R10.9","R11.11","C18.6","Z90.49","Z98.0","R11.10","R93.3","Z85.038","C18.9","K65.9","K66.8","K65.0","C78.6","F17.200","Z79.891","Z79.899","Z92.21","Z92.3","K65.8","K66.0","G89.29","C19","F19.10","R11.0","C78.5","Z80.0","Z87.891","R46.4","R06.00","R45.1","T50.901A","S51.011A","M25.521","R22.0","V89.2XXA","M25.511","V03.10XA","T14.8XXA","M79.631","S51.811A","M79.601","Y93.89","Y92.410","Z23","Z79.82","S52.234A","S41.111A","K85.81","E87.2","C77.2","C79.2","D64.81","C79.89","E87.1","R10.12","D73.89","K66.9","R19.02","R19.09","R10.84","R11.2","G89.3","T45.1X5A","Z86.718","R52","E43","T66.XXXA","D63.0","F17.220","Z68.1","Y84.2","Z87.820","D64.9","D62","D63.8","K86.1","R64","R62.7","C78.89","K59.00","D72.829","F41.9","R91.8","R00.0","D50.0","R19.7","R19.05","Z51.11","Z51.12","C77.9","Z00.00","C78.7","G89.4","M54.5","M79.606"],"date":["2020-05-29","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2021-12-26","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-06-30","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-12-26","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-12-25","2021-12-26","2021-12-25","2021-12-25","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2019-06-09","2019-06-08","2019-07-22","2019-07-29","2019-06-09","2019-07-13","2019-06-09","2019-07-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-07-13","2019-07-07","2019-07-07","2019-06-09","2019-06-08","2019-06-12","2019-07-07","2019-06-11","2019-06-11","2019-06-11","2019-07-07","2019-06-11","2019-06-11","2019-08-01","2019-07-07","2019-07-07","2019-07-08","2019-07-08","2019-07-07","2019-07-07","2019-07-08","2019-07-08","2019-07-07","2019-07-07","2019-07-07","2019-07-08","2019-07-13","2019-07-13","2019-08-19","2019-08-19","2019-07-29","2019-07-29","2019-08-01","2019-10-17","2019-09-19","2019-10-17"],"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":[["","67877022405","GABAPENTIN","CAP 400MG","60","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","7","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","25","Select","Select",""],["","49100040009","CULTURELLE","CAP ","6","Select","Select",""],["","00406902576","FENTANYL","DIS 25MCG\/HR","5","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00054027223","CAPECITABINE","TAB 500MG","84","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","6","Select","Select",""],["","00000000000",""," ","240","Select","Select",""],["","43199001301","HYOSCYAMINE","TAB 0.125MG","120","Select","Select",""],["","00406851501","OXYCODONE","TAB 15MG","90","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","32","Select","Select",""],["","00527145006","DRONABINOL","CAP 2.5MG","60","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","30","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","43598021055","SSD","CRE 0.01","50","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","15","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","10","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}