{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH R HILL","gend":0,"add":"3887 SNEAD SPRING RD ","city":"CREWE ","state":"VA","zip":"23930-9998","dob":"1950-03-05","age":"","mstatus":"","insh":11002462,"cliId":"5VU5D04ME87","pno":4342945552,"cno":4342945552,"email":"","ename":"","eno":"","pphy":"DONOVAN, MARY B","ppno":4347675511,"pcpadd":"412 Namozine St","pcpcity":"Burkeville  ","pcpstate":"VA","pcpzip":239223184,"pcpcounty":"","pcpid":"P9058482","pcpname":"CENTRA SOUTHSIDE PROFESSIONAL LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3887 SNEAD SPRING RD ","madd2":"","madd3":"","mcity":"CREWE ","mstate":"VA","mzip":"23930-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["T14.8XXD","S82.891D","M25.571","Z08","Z85.51","S82.851D","S82.841D","N39.0","B96.20","I11.0","I50.9","I25.10","E11.9","J44.9","M48.061","G43.909","M48.02","M51.36","F17.210","Z99.81","Z79.82","Z79.891","C49.A3","Z98.890","Z79.899","Z79.83","Z85.068","Z86.03","K21.9","E78.2","E78.5","G89.29","F11.20","Z79.02","Z86.73","D64.9","I10","E61.2","Z13.9","Z13.220","Z13.40","Z01.89","C16.9","M96.1","K59.01","N21.0","N40.0","M25.579","I95.1","J43.9","R91.8","D50.9","C67.9","K64.8","F32.9","R07.89","Z23","C49.A0","R31.9","I69.354","Z85.028","I25.2","Z87.442","R51","G50.1","F41.9","Z86.018","R55","R11.0","R10.84","R63.4","K59.00","Z90.49","F12.11","Z71.82","M19.071","Z47.89","S82.851A","R52","D33.3","N28.1","M54.2","M54.5","F12.10","Z85.09","M54.9","J84.10","I20.8","G62.9","R10.9","Z90.6","R19.5","K63.5","K57.30","Z85.038","J98.11","C49.A9","J06.9","I48.3","C80.1","T50.905A","R22.2","E27.8","I77.811","I77.1","M79.89","Z72.0","M47.816","Z87.891","R31.29","R93.41","R39.198","R35.1","F17.200","Z79.01","Z13.89","R31.0","N32.9","R60.9","M50.30","Z98.1","Z01.810","E66.01","Z01.812","D49.4","C67.8","M15.0","Z46.6","R06.09","R59.0","J98.4","R06.02","K59.03","H91.92","C44.89","J96.20","N20.0","N40.1","N13.8","Z71.9","S99.911A","W18.30XA","I44.0","I63.81","R82.90","M62.838","G47.00","Z91.81","S89.91XA","E55.9","S82.831A","S93.04XA","W19.XXXA","S82.851B","S82.891A","I51.7","I77.810","M19.90","K40.20","F33.1","M15.9","R30.9","Z68.28","F41.1","M25.572","R03.0","M72.2","M76.61","S82.91XD","W19.XXXD","R20.8","R20.0","R26.89","M25.671","Z72.89","R68.89","Z74.09","M62.81","R26.81","I69.998","Z85.841","R60.0","S82.891E","G47.8","R26.2","R27.9","Z99.89","I69.352","Z86.2","K76.0","M19.171","Z87.81","J45.909","R91.1","Z85.59","F10.21","N13.9"],"date":["2020-07-27","2020-07-30","2021-05-10","2021-03-22","2021-06-25","2020-09-10","2020-11-12","2020-08-12","2020-08-12","2021-06-25","2021-06-25","2021-05-06","2020-08-12","2021-04-12","2021-02-04","2020-08-12","2021-08-05","2021-02-04","2021-06-25","2021-05-10","2021-06-25","2020-08-13","2021-06-25","2019-08-06","2021-04-15","2019-08-06","2021-04-12","2019-08-06","2021-06-25","2021-05-06","2021-06-25","2021-08-05","2021-08-05","2019-12-17","2019-12-17","2020-08-07","2021-05-10","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2021-05-10","2021-08-05","2021-05-06","2020-09-02","2021-03-17","2020-09-10","2021-05-06","2021-06-22","2021-04-15","2021-03-22","2021-02-04","2018-10-24","2020-06-29","2020-10-26","2020-12-02","2021-06-22","2019-01-22","2021-03-22","2018-11-06","2020-11-17","2019-03-05","2018-11-06","2018-11-06","2018-11-06","2021-04-12","2020-06-29","2019-11-06","2019-11-06","2019-12-17","2019-12-17","2019-11-06","2019-11-08","2019-11-08","2020-11-12","2020-11-12","2020-11-12","2020-11-12","2020-11-17","2021-02-04","2021-06-25","2021-06-25","2020-11-17","2020-11-17","2021-08-05","2020-07-13","2020-12-02","2020-08-21","2019-12-10","2019-12-10","2019-12-17","2019-12-17","2021-06-22","2019-12-17","2020-06-27","2019-01-03","2019-04-09","2019-04-09","2019-01-11","2019-01-11","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-01-22","2019-04-22","2020-02-17","2018-07-11","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2020-06-29","2019-03-05","2019-04-30","2019-03-27","2019-03-27","2018-04-11","2018-05-22","2021-03-24","2019-04-15","2019-04-15","2019-04-16","2019-04-22","2020-06-03","2020-06-03","2019-04-22","2018-05-16","2021-04-15","2018-04-25","2018-05-16","2020-08-21","2020-08-21","2020-06-03","2020-06-03","2021-06-22","2018-06-21","2018-06-21","2018-06-21","2020-06-26","2020-06-26","2020-06-27","2020-06-27","2020-06-28","2020-06-27","2020-06-29","2021-04-12","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-06-28","2020-06-27","2020-06-27","2020-06-29","2020-06-29","2020-06-29","2020-07-13","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2021-01-13","2021-01-22","2021-02-24","2021-05-10","2021-03-24","2021-05-10","2021-04-12","2021-05-10","2021-05-10","2021-05-10","2021-04-12","2021-04-12","2021-04-12","2021-05-10","2021-03-24","2021-03-24","2021-03-24","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-06-15","2021-06-25","2021-06-23","2021-06-23","2021-06-25","2021-03-22","2021-03-22","2021-03-22","2021-11-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","16729009612","QUETIAPINE","TAB 300MG ER","","Select","Select",""],["","378511001","PROCHLORPER","TAB 10MG","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","68382079701","OXYCODONE","TAB 30MG","","Select","Select",""],["","52817036200","METOPROL TAR","TAB 100MG","","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","","Select","Select",""],["","93762998","IMATINIB MES","TAB 100MG","","Select","Select",""],["","47781030701","NITROFUR MAC","CAP 50MG","","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","59011043010","OXYCONTIN","TAB 30MG CR","","Select","Select",""],["","45963055650","GABAPENTIN","CAP 300MG","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","456120230","LINZESS","CAP 290MCG","","Select","Select",""],["","60505014601","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","591060701","LABETALOL","TAB 300MG","","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","","Select","Select",""],["","228212750","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","47335089481","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","172572860","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","527133705","BACLOFEN","TAB 20MG","","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","","Select","Select",""],["","65862020299","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","65862059805","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","378511001","PROCHLORPER ","TAB 10MG","45","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","68382079701","OXYCODONE ","TAB 30MG","60","Select","Select",""],["","93762998","IMATINIB ","TAB 100MG","180","Select","Select",""],["","16729009612","QUETIAPINE ","TAB 300MG ER","30","Select","Select",""],["","52817036200","METOPROL ","TAB 100MG","180","Select","Select",""],["","64764024060","AMITIZA ","CAP 24MCG","60","Select","Select",""],["","59011043010","OXYCONTIN ","TAB 30MG CR","60","Select","Select",""],["","47781030701","NITROFUR ","CAP 50MG","1","Select","Select",""],["","65862020299","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","456120230","LINZESS ","CAP 290MCG","30","Select","Select",""],["","173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","45963055650","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","591060701","LABETALOL ","TAB 300MG","30","Select","Select",""],["","65862018830","ONDANSETRON ","TAB 8MG","60","Select","Select",""],["","57841130101","MOVANTIK ","TAB 25MG","30","Select","Select",""],["","60505014601","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","228212750","CLONIDINE ","TAB 0.1MG","60","Select","Select",""],["","47335089481","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","781261305","AMOXICILLIN ","CAP 500MG","40","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","172572860","FAMOTIDINE ","TAB 20MG","120","Select","Select",""],["","527133705","BACLOFEN ","TAB 20MG","90","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","8","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","57841130101","MOVANTIK","25MG","30","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","00093762998","IMATINIB","100MG","180","Select","Select",""],["","52817036200","METOPROL","100MG","180","Select","Select",""],["","57664050318","TIZANIDINE","4MG","90","Select","Select",""],["","47781030701","NITROFUR","50MG","1","Select","Select",""],["","65862020299","LOSARTAN","50MG","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","57664050318","TIZANIDINE ","TAB 4MG","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":""}]}]}