{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON BLANKENSHIP","gend":1,"add":"205 MAXWELL RD ","city":"TAZEWELL ","state":"VA","zip":"24651-9998","dob":"1962-05-15","age":"","mstatus":"","insh":11005406,"cliId":"6Y96J62NF82","pno":2762458148,"cno":2762458148,"email":"","ename":"","eno":"","pphy":"DUTY, HEATHER K","ppno":"               ","pcpadd":"840 E FINCASTLE RD.,P.O. BOX 948","pcpcity":"TAZEWELL ","pcpstate":"VA","pcpzip":246511419,"pcpcounty":"","pcpid":"P0060310","pcpname":"TAZEWELL FAMILY HEALTHCARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"205 MAXWELL RD ","madd2":"","madd3":"","mcity":"TAZEWELL ","mstate":"VA","mzip":"24651-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G47.33","I10","K46.9","J20.9","R21","E11.65","K43.9","Z01.810","K43.2","F17.210","E11.22","I13.10","N18.2","E03.8","E78.2","M19.90","J44.9","Z79.4","Z88.1","Z88.0","Z98.890","R68.89","M15.0","E88.81","R79.89","R42","Z87.891","R06.02","E03.9","E11.42","Z79.899","E55.9","F32.1","J41.1","M54.5","R51","Z87.19","L30.9","J98.4","R91.1","R91.8","F17.209","R05","Z71.6","F17.219","R07.9","I12.9","I11.9","G47.30","Z79.82","Z99.81","J81.1","F34.1","J30.9","I77.6","N39.0","M25.50","M54.16","M79.671","M79.672","R10.33","R19.8","I87.2","L60.0","D48.5","L29.8","L03.031","K21.9","E07.89","Z12.31","R01.1","Z71.89","Z23","E11.9","M48.061","D25.9","N85.2","M99.73","Z90.49","K86.89","N94.89","L40.8","F41.9","I73.9","F17.200","D25.0","E11.69","E04.2","I65.29","I77.9","R01.0","M79.604","N83.9","N83.8","R93.5","E11.21","Q45.3","R19.00","R19.7","R10.84","N18.31","Z68.29","M25.561","W19.XXXA","S80.211A","S89.91XD","M25.562","N18.9","R07.89","M79.10","I20.8","Z72.0","Z13.6","R94.39","I87.1","N63.25","N63.15","Z71.9","S83.241A","R10.13","S83.232D","Z01.818","D27.0","R93.6","Z09","N83.201","D25.1","N85.8","E78.00","Z79.890","Z20.822","N63.10","N63.20","R10.11","G25.81","E11.40","J01.41","R94.31","I25.118","Z82.49","I25.10","I50.32","E87.6"],"date":["2020-10-06","2021-10-07","2019-01-16","2019-04-09","2019-01-16","2020-07-23","2019-02-18","2021-09-28","2019-02-18","2021-09-28","2021-09-28","2019-02-18","2021-09-28","2021-09-28","2021-10-07","2021-09-28","2021-09-28","2021-09-28","2021-01-25","2021-09-28","2019-05-29","2020-02-26","2019-07-16","2020-03-16","2020-03-17","2019-04-26","2019-05-09","2021-09-28","2021-10-14","2021-08-16","2021-08-16","2019-08-20","2020-08-06","2021-07-26","2020-06-23","2020-05-26","2019-05-29","2020-10-08","2019-06-27","2020-07-30","2021-07-26","2021-07-26","2019-06-27","2019-10-31","2019-10-31","2019-07-02","2021-09-28","2021-10-07","2021-09-28","2019-07-02","2019-07-02","2019-07-08","2020-09-01","2020-07-23","2020-09-08","2021-06-03","2020-08-06","2020-10-13","2020-10-06","2020-10-06","2020-10-13","2020-10-13","2021-10-07","2020-09-22","2020-10-08","2020-10-08","2020-10-06","2021-07-12","2019-11-22","2020-12-03","2019-11-22","2019-10-01","2021-11-11","2021-09-16","2020-10-13","2021-07-12","2020-11-10","2020-10-13","2021-01-25","2020-12-01","2021-07-15","2020-10-22","2019-11-26","2019-10-29","2019-10-29","2020-11-10","2019-11-20","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-26","2021-01-11","2021-01-11","2021-02-16","2021-06-03","2021-02-16","2021-07-15","2021-03-11","2021-03-11","2021-05-17","2021-05-17","2021-04-12","2021-04-12","2021-04-12","2021-07-15","2021-03-11","2021-05-17","2021-09-16","2021-06-03","2021-09-28","2021-10-07","2021-10-07","2021-09-30","2021-06-24","2021-07-19","2021-07-19","2021-06-28","2021-07-15","2021-05-20","2021-08-18","2021-07-08","2021-07-12","2021-07-15","2021-07-15","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-08","2021-07-19","2021-07-19","2021-08-16","2021-09-16","2021-09-16","2021-09-16","2021-09-28","2021-09-30","2021-09-28","2021-10-07","2021-10-07","2021-10-14"],"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":[["","29300012810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","65862020290","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","378181377","LEVOTHYROXIN","TAB 125MCG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","68180046509","SIMVASTATIN","TAB 80MG","","Select","Select",""],["","51862032101","LIOTHYRONINE","TAB 25MCG","","Select","Select",""],["","193725201","CONTOUR","KIT NEXT EZ","","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","","Select","Select",""],["","173085910","BREO ELLIPTA","INH 100-25","","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","","Select","Select",""],["","69047103","CHANTIX","PAK 0.5& 1MG","","Select","Select",""],["","70461031903","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","597015561","STIOLTO","AER 2.5-2.5","","Select","Select",""],["","52937000120","VASCEPA","CAP 1GM","","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","193654621","BAYER MICRLT","MIS LANCETS","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","","Select","Select",""],["","68382025601","OXYBUTYNIN","TAB 10MG ER","","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","","Select","Select",""],["","51672300302","HYDROCORT","CRE 0.025","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","","Select","Select",""],["","61442011301","ACYCLOVIR","TAB 800MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","93031401","KETOROLAC","TAB 10MG","","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","","Select","Select",""],["","66758019001","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","378827052","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","8290320550","BD PEN NEEDL","MIS 32GX5\/32","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","33342032980","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","43386009661","CLOBETASOL","OIN 0.0005","","Select","Select",""],["","173085910","BREO ","INH 100-25","60","Select","Select",""],["","43598075201","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","378181510","LEVOTHYROXIN ","TAB 150MCG","30","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","69047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","65862020290","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","51862032101","LIOTHYRONINE ","TAB 25MCG","30","Select","Select",""],["","68180046509","SIMVASTATIN ","TAB 80MG","90","Select","Select",""],["","193725201","CONTOUR ","KIT NEXT EZ","1","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","45","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","597015230","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","180","Select","Select",""],["","8290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","52937000120","VASCEPA ","CAP 1GM","360","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","597015561","STIOLTO ","AER 2.5-2.5","4","Select","Select",""],["","193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","180","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","10","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","90","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","378064110","PREDNISONE ","TAB 10MG","37","Select","Select",""],["","68382025601","OXYBUTYNIN ","TAB 10MG ER","90","Select","Select",""],["","51672300302","HYDROCORT ","CRE 0.025","28.35","Select","Select",""],["","186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","43386009661","CLOBETASOL ","OIN 0.0005","30","Select","Select",""],["","61442011301","ACYCLOVIR ","TAB 800MG","50","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","93031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","21","Select","Select",""],["","378827052","ALBUTEROL ","NEB 0.00083","300","Select","Select",""],["","66758019001","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","33342032980","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","193658621","MICROLET ","LANCETS","100","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","65862020290","LOSARTAN","50MG","30","Select","Select",""],["","70461031903","FLUCLVX","2019-20","0.5","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00378064110","PREDNISONE","10MG","37","Select","Select",""],["","00193654621","BAYER","LANCETS","100","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","53489011905","DOXYCYCL","100MG","14","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","66758019001","KLOR-CON","20MEQ ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","70436000203","POT CHLORIDE","10MEQ ER","5","Select","Select",""],["","68382065005","ISOSORB","30MG ER","30","Select","Select",""],["","68180071909","AMLODIPINE","2.5MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","3","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0.5","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","5","Select","Select",""],["","62175061846","PANTOPRAZOLE ","TAB 20MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","0.5","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","68180071909","AMLODIPINE ","TAB 2.5MG","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":""}]}]}