{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WARREN O ROBERTS","gend":0,"add":"1148MEADOW LAKE DRIVE","city":"BEDFORD  ","state":"VA","zip":"24523-6099","dob":"1953-03-18","age":"","mstatus":"","insh":11001341,"cliId":"7NR6TK7JG56","pno":5408160489,"cno":5408160791,"email":"","ename":"","eno":"","pphy":"COHEN, LEONARD J  ","ppno":5405866818,"pcpadd":"1615 Oakwood St","pcpcity":"BEDFORD  ","pcpstate":"VA","pcpzip":245231249,"pcpcounty":"","pcpid":"P0124550","pcpname":"BEDFORD COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"LOT 8 ","add3":"","madd1":"1148MEADOW LAKE DRIVE","madd2":"LOT 8 ","madd3":"","mcity":"BEDFORD  ","mstate":"VA","mzip":"24523-6099","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","F33.1","F41.9","E78.2","K21.9","J30.2","N52.8","E55.9","J44.1","J01.00","J20.9","J45.909","J44.9","R26.2","G62.9","Z71.3","G47.34","N20.0","Z72.0","Z71.9","R09.02","J34.89","R39.198","Z00.01","Z13.89","Z71.89","Z87.442","Z23","Z91.81","L85.2","M79.671","M79.672","E11.9","B37.0","Z13.9","J98.8","H04.123","B37.42","K04.7","J32.0","W57.XXXA","D12.0","D12.2","D12.3","D12.4","R19.5","K64.0","K57.30","K62.1","I44.7","E78.5","Z99.81","F17.220","Z83.3","Z82.49","D12.6","K63.5","H35.371","H25.13","H61.23","H35.373","N52.9","J32.9","J98.4","D49.2","R21","E11.40","Z11.59","G47.30","G47.10","R06.83","R09.89","A41.9","R07.9","J15.9","Z20.822","J96.01","E87.1","E87.6","R19.7","F17.210","Z79.899","Z79.51","R91.8","Z09","R53.1","J18.9","F32.9","Z88.1","Z88.0","H40.013","Z91.09","M51.26","F17.229","R13.10"],"date":["2021-09-09","2021-09-09","2021-09-09","2021-05-04","2021-05-04","2020-06-26","2021-09-09","2019-01-31","2019-01-31","2019-01-31","2019-02-12","2021-11-08","2021-09-09","2020-02-17","2021-09-09","2020-02-17","2021-11-08","2020-03-12","2021-11-08","2018-06-15","2018-06-15","2018-03-15","2020-03-30","2021-09-09","2021-09-09","2021-09-09","2020-03-30","2021-11-08","2020-03-31","2020-04-15","2021-01-13","2020-04-15","2021-09-09","2019-05-16","2018-06-15","2020-06-16","2020-09-03","2020-06-29","2020-06-29","2020-06-29","2019-07-18","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2018-07-24","2021-06-16","2018-07-24","2018-07-24","2021-11-08","2021-08-20","2021-08-20","2021-05-04","2019-10-25","2018-11-05","2018-11-08","2021-11-08","2020-11-23","2021-01-04","2021-01-13","2020-12-03","2021-02-08","2021-02-08","2021-02-08","2021-06-08","2021-06-17","2021-06-16","2021-06-16","2021-06-16","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-29","2021-06-16","2021-11-08","2021-06-16","2021-06-16","2021-06-16","2021-08-20","2021-09-09","2021-09-09","2021-09-09","2021-11-08"],"priorHcc":["","","","","","","","","","","",null,"","","","",null,"",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","",null]}},{"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":[["","173088710","TRELEGY","AER ELLIPTA","","Select","Select",""],["","69097031987","BUDESONIDE","SUS 0.5MG\/2","","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","","Select","Select",""],["","193731221","CONTOUR","TES NEXT","","Select","Select",""],["","487950103","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","193658621","MICROLET","MIS LANCETS","","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","","Select","Select",""],["","68001033508","LISINOPRIL","TAB 20MG","","Select","Select",""],["","378261001","AMITRIPTYLIN","TAB 10MG","","Select","Select",""],["","173088210","BREO ELLIPTA","INH 200-25","","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","228300311","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","68180046803","LOVASTATIN","TAB 20MG","","Select","Select",""],["","16714093701","ATENOL\/CHLOR","TAB 100-25MG","","Select","Select",""],["","57237010299","METOPROL TAR","TAB 100MG","","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","","Select","Select",""],["","24208078055","NEO\/BAC\/POLY","OIN OP","","Select","Select",""],["","310620530","FARXIGA","TAB 5MG","","Select","Select",""],["","10370010150","BUPROPN HCL","TAB 150MG XL","","Select","Select",""],["","50228013690","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","","Select","Select",""],["","597002402","COMBIVENT","AER 20-100","","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","","Select","Select",""],["","59762054201","GLIPIZIDE XL","TAB 10MG","","Select","Select",""],["","65162017850","METFORMIN","TAB 500MG ER","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","76204060060","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","16714069211","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","16714049601","CLOTRIM\/BETA","CRE 1-0.05%","","Select","Select",""],["","58160081912","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","93314705","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","143980350","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","173088710","TRELEGY ","AER ELLIPTA","180","Select","Select",""],["","193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","65162067684","AZELASTINE ","SPR 0.001","90","Select","Select",""],["","378261001","AMITRIPTYLIN ","TAB 10MG","90","Select","Select",""],["","68001033508","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","487950103","ALBUTEROL ","NEB 0.00083","810","Select","Select",""],["","173088210","BREO ","INH 200-25","180","Select","Select",""],["","69097031987","BUDESONIDE ","SUS 0.5MG\/2","360","Select","Select",""],["","228300311","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","57237010299","METOPROL ","TAB 100MG","90","Select","Select",""],["","68180046803","LOVASTATIN ","TAB 20MG","180","Select","Select",""],["","93645156","ESOMEPRA ","CAP 40MG DR","90","Select","Select",""],["","70710116801","ATENOL\/CHLOR ","TAB 100-25MG","90","Select","Select",""],["","72205002405","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","90","Select","Select",""],["","597002402","COMBIVENT ","AER 20-100","4","Select","Select",""],["","24208078055","NEO\/BAC\/POLY ","OIN OP","3.5","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","90","Select","Select",""],["","50228013690","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","310620530","FARXIGA ","TAB 5MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","65162046550","IBUPROFEN ","TAB 600MG","15","Select","Select",""],["","16714049601","CLOTRIM\/BETA ","CRE 1-0.05%","15","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","140","Select","Select",""],["","59762054201","GLIPIZIDE ","TAB 10MG","90","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","143980350","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","SOL ALBUTER","1,080.00","Select","Select",""],["","65162017850","METFORMIN ","TAB 500MG ER","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","16714069211","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","31722072320","LEVOFLOXACIN ","750MG","5","Select","Select",""],["","00173088210","BREO","200-25","180","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","57237010299","METOPROL","100MG","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59762054201","GLIPIZIDE","10MG","180","Select","Select",""],["","00093645156","ESOMEPRA","40MG DR","90","Select","Select",""],["","10370010150","BUPROPN","150MG XL","90","Select","Select",""],["","31722072320","LEVOFLOXACIN","750MG","5","Select","Select",""],["","00143980350","DOXYCYCL","100MG","28","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","45963055650","GABAPENTIN","300MG","90","Select","Select",""],["","45963055650","GABAPENTIN ","CAP 300MG","90","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}