{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NINA R SHUTKO","gend":1,"add":"292 JAY ST","city":"GATE CITY","state":"VA","zip":242519999,"dob":"1953-02-03","age":"","mstatus":"","insh":11003673,"cliId":"7AN1HX7TK97","pno":2765942059,"cno":"","email":"","ename":"","eno":"","pphy":"EASTRIDGE, WESLEY V","ppno":2763863411,"pcpadd":"390 Kane St","pcpcity":"Gate City","pcpstate":"VA","pcpzip":242512753,"pcpcounty":"","pcpid":"P9058844","pcpname":"MOUNTAIN REGION FAMILY MEDICINE","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":["J44.9","M15.9","M48.00","R29.6","J44.0","D50.9","G40.909","F20.9","F17.200","F41.1","M16.11","J96.11","C34.90","M48.54XA","D75.89","F32.9","F41.9","I70.0","K21.9","K59.00","K80.20","M19.079","M20.10","M46.90","M51.36","M85.80","M25.551","R53.1","Z74.09","R26.9","M84.48XA","Z99.81","Z87.891","R55","J43.9","T14.90XA","R53.81","T50.904A","F33.9","D48.0","I10","E78.5","F33.1","G47.00","D64.9","M19.91","M62.81","M62.50","Z51.81","Z79.01","R44.1","R91.8","R64","S22.000A","E03.9","J30.9","J44.1","Z95.2","G89.29","R56.9","D38.1","S22.008D","S29.9XXA","W19.XXXA","S39.91XA","S24.109A","S39.92XA","R79.1","C34.11","F20.0","R94.6","B99.9","E55.9","M81.0","M48.02","R42","I05.9","C34.10","E78.00","M54.05","R74.8","Z79.899","C34.12","E53.9","I34.0","Z68.1","Z87.820","D51.9","Z95.4","J43.2","R06.02","Z79.1","R91.1","R94.2","J93.9","F17.210","C34.92","J95.811","R63.4","R73.01","Z23","Z51.0","R26.89","Z91.81","F64.9","E53.8"],"date":["2021-06-01","2020-01-01","2020-01-01","2020-01-21","2020-01-01","2020-01-01","2021-05-14","2021-05-07","2020-07-01","2021-05-07","2020-01-17","2020-04-06","2020-01-18","2020-01-14","2020-01-14","2020-02-01","2020-02-01","2020-01-14","2020-02-13","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-10-05","2020-02-08","2020-01-18","2020-01-14","2020-01-18","2020-01-18","2020-12-17","2020-09-21","2020-02-01","2020-01-14","2020-01-14","2020-01-17","2020-01-18","2021-05-07","2020-04-06","2020-04-06","2020-03-06","2020-02-01","2020-02-01","2021-05-14","2020-02-20","2020-02-01","2020-01-18","2020-10-20","2020-12-17","2020-01-21","2020-10-12","2020-02-13","2020-02-13","2020-01-22","2020-02-06","2020-04-06","2020-10-12","2020-02-08","2020-02-13","2020-04-06","2020-04-06","2019-02-21","2019-03-13","2019-02-21","2019-02-21","2019-02-21","2020-02-24","2021-05-14","2021-05-14","2020-03-06","2020-03-06","2021-03-29","2020-10-05","2021-03-29","2019-09-06","2020-06-17","2021-03-29","2021-03-25","2021-03-29","2021-03-29","2020-10-01","2021-06-28","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-07-21","2018-09-24","2020-10-12","2020-10-12","2018-09-12","2020-09-14","2020-10-12","2020-10-05","2020-10-12","2020-10-19","2020-10-12","2021-03-25","2018-10-24","2019-11-20","2020-12-02","2018-11-16","2019-12-16","2021-03-18","2021-03-29"],"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":[["","55111012105","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","59762521001","PHENYTOIN","CHW 50MG","","Select","Select",""],["","66993068330","OLANZAPINE","TAB 10MG","","Select","Select",""],["","10702001110","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","115165903","PROPRANOLOL","TAB 10MG","","Select","Select",""],["","16729017017","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","","Select","Select",""],["","16714071503","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","","Select","Select",""],["","65862069299","PHENYTOIN EX","CAP 100MG","","Select","Select",""],["","93171601","WARFARIN","TAB 4MG","","Select","Select",""],["","143980305","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","955100410","ENOXAPARIN","INJ 40\/0.4ML","","Select","Select",""],["","76385010310","BENZTROPINE","TAB 0.5MG","","Select","Select",""],["","16714097601","DICLOFENAC","GEL 0.01","","Select","Select",""],["","60505024708","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","185067401","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","487950160","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","","Select","Select",""],["","76385010310","BENZTROPINE ","TAB 0.5MG","180","Select","Select",""],["","59762521001","PHENYTOIN ","CHW 50MG","30","Select","Select",""],["","55111012105","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","66993068330","OLANZAPINE ","TAB 10MG","30","Select","Select",""],["","10702001110","HYDROXYZ ","TAB 25MG","360","Select","Select",""],["","16729017017","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","16714071503","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","57237012301","WARFARIN ","TAB 4MG","90","Select","Select",""],["","603548221","PROPRANOLOL ","TAB 10MG","30","Select","Select",""],["","43547028810","BUPROPION ","TAB 100MG SR","30","Select","Select",""],["","16714063301","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","57237000905","MIRTAZAPINE ","TAB 30MG","90","Select","Select",""],["","548560200","ENOXAPARIN ","INJ 40\/0.4ML","5.6","Select","Select",""],["","143980305","DOXYCYCL ","CAP 100MG","6","Select","Select",""],["","16714097601","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","487950160","ALBUTEROL ","NEB 0.00083","360","Select","Select",""],["","65862018830","ONDANSETRON ","TAB 8MG","60","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}