{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA E GUYNN","gend":1,"add":"255BENTLEY HOLLOW ROAD  ","city":"PULASKI  ","state":"VA","zip":"24301-6122","dob":"1986-03-17","age":"","mstatus":"","insh":11000197,"cliId":"4TY8RV6JE61","pno":5406160312,"cno":5402005347,"email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO D  ","ppno":5407693964,"pcpadd":"2900 LAMB CIRCLE","pcpcity":"CHRISTIANSBURG ","pcpstate":"VA","pcpzip":240736344,"pcpcounty":"","pcpid":"P0124422","pcpname":"PULASKI HEALTH AND REHAB CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"LOT 32","add3":"","madd1":"255BENTLEY HOLLOW ROAD  ","madd2":"LOT 32","madd3":"","mcity":"PULASKI  ","mstate":"VA","mzip":"24301-6122","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R51","R00.0","I10","J45.909","M54.2","H66.92","M25.512","S46.912A","X50.0XXA","M62.838","X50.1XXA","R10.13","R11.2","R19.7","R11.0","R10.9","J06.9","R05","F32.9","I49.9","F41.9","F39","N19","R73.09","D64.9","E03.9","A64","M25.552","Z13.220","M25.50","M25.511","M25.551","S76.011A","M25.559","X50.9XXA","Y93.E6","Y92.9","Z87.891","R60.0","M79.604","M79.605","M79.89","R04.0","G89.29","E61.2","E55.9","E83.59","E83.39","K76.9","N39.0","R94.5","M95.0","J34.2","J32.2","M54.9","G43.909","H92.02","R09.81","F17.200","J34.89","T63.301A","M79.641","M25.561","M70.51","W18.30XA","S80.01XA","S80.02XA","M71.9","R10.0","R10.30","R30.0","M79.661","R53.83","M54.5","Z00.01","Z68.29","S00.33XA","W50.0XXA","M54.6","Z68.27","H10.9","J32.9","H57.89","Z09","D72.829","Z68.28","R10.811","M62.830","S93.501A","M79.674","W22.8XXA","Y92.833","M25.531","W19.XXXA","M54.42","E05.90","Z00.00","T14.90XA","S46.902A","X58.XXXA","J01.00","J30.2","R22.1","R51.9","S16.1XXA","V40.5XXA","G43.001","M25.519","S49.92XA","J01.10","L50.9","G89.11","R29.6","G44.229","G44.209","S80.11XA","Z76.0","W18.40XA","R20.0","F19.11"],"date":["2020-07-14","2020-11-18","2020-11-18","2021-08-13","2021-08-13","2019-09-20","2021-01-21","2019-08-24","2021-01-21","2021-01-26","2019-01-14","2018-01-20","2021-01-26","2020-07-14","2020-12-21","2018-01-30","2020-02-17","2020-02-17","2020-12-21","2018-04-04","2020-11-18","2018-04-04","2018-04-04","2018-04-04","2018-06-19","2018-05-02","2018-04-04","2018-04-08","2019-04-09","2018-04-13","2020-04-20","2020-05-26","2018-04-21","2018-05-24","2018-04-21","2018-04-21","2018-04-21","2020-06-17","2020-04-25","2020-06-23","2020-04-25","2020-06-23","2018-04-30","2020-08-09","2018-05-02","2018-05-02","2018-05-02","2018-05-02","2018-05-02","2018-07-19","2018-07-19","2021-07-23","2018-05-14","2018-05-14","2018-06-19","2021-01-26","2019-09-20","2019-06-30","2021-07-23","2021-07-23","2018-06-03","2019-08-02","2020-06-04","2020-06-04","2020-06-17","2021-06-13","2020-06-04","2020-06-04","2018-06-14","2018-07-07","2018-06-14","2020-06-17","2018-06-18","2020-08-09","2018-06-18","2018-06-18","2018-06-19","2018-06-19","2018-06-19","2018-07-19","2019-06-30","2019-06-30","2019-06-30","2018-11-28","2018-07-09","2018-07-09","2018-07-19","2019-07-24","2018-07-27","2018-07-27","2018-08-07","2018-07-27","2019-08-02","2018-08-07","2020-08-09","2020-11-18","2018-08-22","2019-08-24","2019-08-24","2021-08-13","2018-09-04","2018-09-04","2019-09-20","2021-08-13","2021-08-13","2018-11-12","2020-11-18","2018-11-23","2018-11-23","2018-11-23","2019-11-23","2018-12-15","2018-12-15","2021-04-23","2021-04-23","2021-06-13","2021-06-13","2021-06-13","2021-08-13","2021-07-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111017915","TIZANIDINE","TAB 2MG","","Select","Select",""],["","591544305","PREDNISONE","TAB 20MG","","Select","Select",""],["","29300013005","HYDROCHLOROT","CAP 12.5MG","","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","","Select","Select",""],["","43547035311","LISINOPRIL","TAB 10MG","","Select","Select",""],["","57237010001","METOPROL TAR","TAB 25MG","","Select","Select",""],["","65862050220","AMOX\/K CLAV","TAB 500-125","","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","","Select","Select",""],["","603548421","PROPRANOLOL","TAB 40MG","","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","9","Select","Select",""],["","591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","16729016917","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","29300013005","HYDROCHLOROT ","CAP 12.5MG","10","Select","Select",""],["","10702000310","PROMETHAZINE ","TAB 25MG","8","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","57237010001","METOPROL ","TAB 25MG","30","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","14","Select","Select",""],["","603548421","PROPRANOLOL ","TAB 40MG","90","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","65862050220","AMOX\/K","500-125","14","Select","Select",""],["","57237010001","METOPROL","25MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}