{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM J GRIZZLE","gend":0,"add":"721 E RIVER ST N","city":"BIG STONE GAP","state":"VA","zip":242199999,"dob":"1966-06-04","age":"","mstatus":"","insh":11003301,"cliId":"8NE8G55GQ44","pno":2762203637,"cno":2765942660,"email":"","ename":"","eno":"","pphy":"VANZEE, WAYNE A","ppno":2763834228,"pcpadd":"100 MAIN STREET","pcpcity":"SAINT CHARLES","pcpstate":"VA","pcpzip":242820001,"pcpcounty":"","pcpid":"P0060054","pcpname":"ST CHARLES COMMUNITY HEALTH CLINIC","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z89.611","E11.40","Z89.612","J44.9","F95.2","G89.4","R33.9","I11.9","B99.9","E53.9","I10","E11.59","D50.0","M19.041","M65.341","M79.642","M62.81","Z47.81","E11.51","N31.9","S34.109S","I13.0","G54.6","N31.8","M54.5","M48.02","M19.90","L89.012","Z46.6","R39.81","L22","I69.354","R26.89","M54.2","Z51.81","Z00.8","Z13.9","Z13.89","F17.200","R32","E11.9","E03.9","R79.89","R68.89","E78.5","R94.5","D51.9","R73.09","E83.10","R79.0","N39.0","L89.319","L89.329","Z12.11","D64.9","D52.9","I50.32","E11.22","N18.2","L89.610","L89.890","L89.620","R60.9","L97.919","L97.929","D63.1","L97.419","E11.621","Z01.812","L97.429","Z01.810","G12.20","R53.1","I50.9","G81.94","J96.10","I73.9","E11.65","N18.9","Z99.81","I70.243","I70.233","L97.329","L97.319","F17.210","L97.413","I11.0","J96.11","B37.2","K21.9","A04.72","Z13.0","M79.641","A41.9","J18.1","J96.21","R09.02","J69.0","E87.1","E11.622","G47.30","R27.9","R26.2","Z79.4","R06.00","R13.12","F41.9","L89.151","E61.1","G47.33","R70.0","R13.10","E66.9","D51.0","Z79.899","R19.7","R91.8","Z09","C82.30","M24.541","R19.5","A04.4","E13.621","R50.9","R10.84","Z74.01","T83.091A","Y73.8","T83.098A","M67.949","L89.510","L89.159","Z86.73","I70.234","L89.152","F33.9","D50.9","L89.312","L89.322","L89.022","M24.542","M65.342","R05","I50.30","Z23","R45.89","R82.90","D53.0","M86.9","G56.32","M65.331","L89.150","L89.321","E08.40"],"date":["2021-05-17","2021-05-17","2020-12-14","2021-05-17","2020-03-19","2021-06-09","2019-01-03","2019-07-03","2020-03-31","2020-01-08","2021-06-09","2020-01-08","2020-05-19","2020-01-13","2021-02-01","2020-12-17","2021-02-12","2019-01-31","2021-06-09","2021-06-15","2020-07-14","2021-05-01","2020-11-16","2020-07-14","2021-05-17","2020-07-14","2020-01-16","2020-03-04","2021-05-01","2021-06-14","2021-06-14","2021-06-15","2021-06-14","2021-05-17","2021-05-17","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-05-17","2021-04-22","2019-02-08","2020-09-16","2020-09-16","2020-06-01","2020-02-20","2020-06-09","2020-06-01","2020-02-20","2020-02-20","2021-02-23","2021-06-14","2021-06-14","2020-06-12","2021-06-09","2020-09-01","2021-05-01","2021-05-01","2021-05-01","2018-08-27","2018-04-03","2018-04-03","2018-04-03","2018-04-18","2018-04-18","2021-05-01","2018-09-21","2018-08-28","2018-04-18","2018-04-24","2018-04-18","2019-04-21","2019-05-01","2019-04-21","2018-04-24","2018-04-24","2020-11-16","2020-12-14","2018-04-24","2018-04-24","2018-04-24","2018-04-24","2018-04-24","2018-08-28","2018-08-28","2018-07-01","2018-07-01","2018-09-01","2018-05-01","2018-09-01","2019-05-16","2019-05-16","2020-05-28","2019-08-15","2018-07-01","2018-06-01","2018-05-29","2018-05-29","2018-05-29","2018-08-28","2018-05-29","2018-05-29","2018-05-29","2020-12-14","2018-05-29","2018-07-01","2021-03-16","2021-01-01","2020-07-14","2020-07-14","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-12","2020-06-18","2018-07-01","2018-07-01","2020-07-02","2019-07-10","2020-07-13","2020-07-13","2018-09-21","2019-08-15","2019-08-15","2020-12-14","2019-08-15","2019-08-15","2019-08-15","2020-08-25","2018-08-28","2021-06-14","2018-08-28","2018-08-28","2018-09-01","2021-03-16","2020-09-01","2019-10-02","2021-05-01","2019-10-02","2020-11-16","2020-10-01","2018-10-10","2019-10-10","2020-11-16","2019-10-17","2018-10-24","2020-11-02","2020-12-14","2021-02-01","2021-02-01","2021-05-01","2021-05-01","2021-03-26"],"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":[["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","93031101","LOPERAMIDE","CAP 2MG","","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","169643810","LEVEMIR","INJ FLEXTOUC","","Select","Select",""],["","16729020301","BUSPIRONE","TAB 15MG","","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","","Select","Select",""],["","68382007901","HALOPERIDOL","TAB 5MG","","Select","Select",""],["","8290328411","INSULIN SYRG","MIS 1ML\/30G","","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","69097082707","BENZTROPINE","TAB 1MG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","","Select","Select",""],["","43547034106","RISPERIDONE","TAB 1MG","","Select","Select",""],["","68382039801","POT CHLORIDE","TAB 20MEQ ER","","Select","Select",""],["","56151146003","TRUE METRIX","TES GLUCOSE","","Select","Select",""],["","66758019001","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","68180030260","CEFUROXIME","TAB 250MG","","Select","Select",""],["","98302000100","SIMPLE DIAG","MIS LANCING","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","121057716","LACTULOSE","SOL 10GM\/15","","Select","Select",""],["","98302000160","ULTRA THIN","MIS 31G","","Select","Select",""],["","98302000105","ALCOHOL PREP","PAD ","","Select","Select",""],["","8290320109","BD PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","68462056417","MUPIROCIN","CRE 0.02","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","53885024510","ONETOUCH ","TES ULTRA","100","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","75","Select","Select",""],["","169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","65862019405","FLUOXETINE ","CAP 40MG","90","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","120","Select","Select",""],["","68382007901","HALOPERIDOL ","TAB 5MG","270","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","90","Select","Select",""],["","65862052405","GABAPENTIN ","TAB 800MG","135","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","180","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","8290328411","INSULIN ","MIS 1ML\/30G","100","Select","Select",""],["","93031101","LOPERAMIDE ","CAP 2MG","60","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","68462056417","MUPIROCIN ","CRE 0.02","15","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","3","Select","Select",""],["","57664051083","MIRTAZAPINE ","TAB 7.5MG","90","Select","Select",""],["","603243821","BENZTROPINE ","TAB 1MG","180","Select","Select",""],["","56151146003","TRUE ","TES GLUCOSE","100","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","180","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","180","Select","Select",""],["","121087316","LACTULOSE ","SOL 10GM\/15","2,838.00","Select","Select",""],["","66758019001","KLOR-CON ","TAB 20MEQ ER","180","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","8290320109","BD  PEN NEEDL","MIS 31GX8MM","300","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","99073014002","FREESTYLE    LIQ CONTROL","LIQ CONTROL","1","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","400","Select","Select",""],["","98302000160","ULTRA ","MIS 31G","400","Select","Select",""],["","98302000100","SIMPLE ","MIS LANCING","1","Select","Select",""],["","98302000105","ALCOHOL ","PAD ","400","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","68180030260","CEFUROXIME ","TAB 250MG","20","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","57599000021","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","61314063305","GENTAMICIN ","SOL 0.3% OP","5","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","45","Select","Select",""],["","8627009111","DEXCOM ","RECEIVER","1","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}