{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGE E BLANKENSHIP","gend":0,"add":"257 CUMBERLAND RD","city":"CEDAR BLUFF","state":"VA","zip":246099999,"dob":"1940-02-16","age":"","mstatus":"","insh":11007150,"cliId":"4NH1YV8EW11","pno":2769640434,"cno":"","email":"","ename":"","eno":"","pphy":"GOODMAN, ASHLEY D","ppno":2769646771,"pcpadd":"295 Wharton Ln NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"P0060216","pcpname":"CLINCH VALLEY PHYSICIANS ASSOCIATES LLC","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":["S72.001D","Z96.641","F79","I10","H54.8","K21.9","N40.0","N39.46","Z96.642","R97.20","R33.9","R31.9","N40.1","R39.81","S72.001A","N28.1","Z96.643","R31.29","M25.562","F17.200","M25.552","L02.612","F39","S72.002B","S72.002D","F03.90","R76.11","D64.9","Z79.01","Z85.828","F91.9","M16.11","Z86.11","Z00.00","Z13.1","Z13.6","S69.91XA","H10.9","R05","L82.1","L81.4","D18.01","D48.5","L57.0","S62.656A","S62.656D","J20.9","S00.12XA","R07.89","R07.9","R10.13","W19.XXXA","M43.8X6","M43.8X4","I71.2","Z66","E87.1","I45.10","I70.90","R10.9","D48.0","L72.0","L98.499","L21.8","R06.2","J01.80","M25.461","M25.551","M79.601","E11.9","D72.829","M80.051A","F06.8","Y92.199","D62","N39.0","J44.0","F17.210","D50.9","R79.89","R27.0","S72.041A","R00.2","J44.9","M81.0","G81.90","S72.051A","Z47.1","I25.10","M84.359A","S72.011A","Z22.7","J06.9","R60.9","B35.1","M79.674","G47.00","S72.011D","M25.559","R41.82","R45.1","H57.89","M79.605","R60.0","R22.40","R41.0","R60.1","Z79.899","Z79.82","Q04.0","N32.81","N39.44","U07.1","J12.82","J96.01","Z87.891","Z79.1","N28.9","R06.02","R09.02","J12.89","E78.5","K64.9","J30.2","K29.70","F32.89","F73","Z87.81","I77.2","Z68.23","R00.0","R91.8","J18.9","J98.11","F72","Z86.16","I50.9","I13.0","R68.89","R78.89","K59.00","R06.00","R40.0","M47.816","M51.36","J44.1","S22.000A","M54.5","W05.0XXA","S32.000A","S32.020A","S32.030A","S22.080A","S32.010A","J42","K59.03","T42.75XA","S79.911A","S79.912A","S39.92XA","N18.2"],"date":["2020-02-01","2020-02-01","2021-05-04","2021-06-15","2021-05-04","2021-05-04","2021-06-15","2020-02-01","2020-02-01","2020-01-21","2020-01-21","2020-01-14","2020-01-21","2020-01-21","2021-06-04","2020-01-14","2020-01-14","2020-01-21","2020-01-23","2020-01-23","2020-01-23","2020-03-05","2020-11-12","2021-06-04","2019-04-02","2019-11-14","2019-07-27","2020-08-13","2019-04-02","2021-05-04","2021-03-11","2019-04-17","2019-04-17","2021-05-05","2019-05-03","2019-05-03","2019-06-01","2020-06-11","2021-06-04","2019-06-17","2019-06-17","2019-06-17","2019-07-31","2019-06-17","2019-06-19","2019-06-19","2021-01-21","2019-07-24","2019-07-27","2021-05-04","2019-07-27","2020-11-12","2019-07-27","2019-07-27","2019-07-29","2021-01-31","2021-06-15","2021-01-31","2019-07-29","2019-07-28","2019-07-31","2019-07-31","2019-07-31","2019-08-08","2020-08-21","2019-09-11","2019-09-24","2019-11-11","2019-09-24","2020-08-13","2019-09-24","2019-09-26","2019-09-26","2019-09-24","2019-10-07","2019-10-07","2019-10-07","2021-05-04","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-25","2021-06-04","2019-09-27","2019-09-27","2019-09-27","2019-09-27","2019-11-01","2019-10-09","2019-11-14","2019-11-14","2020-10-29","2019-11-21","2019-11-05","2019-11-05","2020-11-12","2019-11-18","2020-11-12","2021-05-04","2020-11-12","2019-11-21","2019-11-21","2021-06-15","2019-11-21","2019-11-21","2019-11-21","2021-05-04","2021-05-04","2019-11-21","2020-11-25","2020-11-25","2021-04-05","2021-02-10","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-05-04","2021-01-31","2021-02-10","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2021-01-31","2021-02-02","2021-02-02","2021-02-02","2021-03-11","2021-04-07","2021-04-15","2021-04-28","2021-04-28","2021-04-28","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-05","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-03","2021-05-04","2021-05-04","2021-05-08","2021-05-08","2021-05-08","2021-06-15"],"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":[["","54429731","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","","Select","Select",""],["","67877019810","AMLODIPINE","TAB 5MG","","Select","Select",""],["","54001829","PREDNISONE","TAB 20MG","","Select","Select",""],["","29300013905","DIVALPROEX","TAB 250MG DR","","Select","Select",""],["","60505025801","DESMOPRESSIN","TAB 0.2MG","","Select","Select",""],["","69097094615","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","47335090488","QUETIAPINE","TAB 100MG","","Select","Select",""],["","49281042010","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","","Select","Select",""],["","469260190","MYRBETRIQ","TAB 25MG","","Select","Select",""],["","55111064505","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","","Select","Select",""],["","65862098799","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","45802004064","SELENIUM SUL","LOT 0.025","","Select","Select",""],["","67877029505","IBUPROFEN","TAB 600MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","67405055005","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","","Select","Select",""],["","487950125","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","406012301","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","68382011405","RISPERIDONE","TAB 1MG","","Select","Select",""],["","62037071001","POT CL MICRO","TAB 10MEQ CR","","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","378797052","IPRATROPIUM","SOL 0.02%INH","","Select","Select",""],["","55111059705","MEMANTINE","TAB HCL 10MG","","Select","Select",""],["","3089321","ELIQUIS","TAB 2.5MG","","Select","Select",""],["","555007102","ISONIAZID","TAB 300MG","","Select","Select",""],["","53489014605","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","54418325","DEXAMETHASON","TAB 2MG","","Select","Select",""],["","42043025006","CEFDINIR","CAP 300MG","","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","","Select","Select",""],["","55111064505","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","65862098799","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","65862059805","TAMSULOSIN ","CAP 0.4MG","60","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","54429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","60","Select","Select",""],["","67877051310","ATORVASTATIN ","CAL CIUM ORAL","30","Select","Select",""],["","469260190","MYRBETRIQ ","TAB 25MG","30","Select","Select",""],["","10702017001","DESMOPRESSIN ","TAB 0.2MG","60","Select","Select",""],["","54001829","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","65862019405","FLUOXETINE ","CAP 40MG","31","Select","Select",""],["","16729014717","QUETIAPINE ","TAB 100MG","31","Select","Select",""],["","29300013905","DIVALPROEX ","TAB 250MG DR","124","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","14","Select","Select",""],["","49281042010","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","487950125","ALBUTEROL ","NEB 0.00083","150","Select","Select",""],["","406012301","HYDROCO\/APAP ","TAB 5-325MG","60","Select","Select",""],["","45802004064","SELENIUM ","LOT 0.025","120","Select","Select",""],["","67877029505","IBUPROFEN ","TAB 600MG","48","Select","Select",""],["","61314062810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","487020160","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","42043025006","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","14","Select","Select",""],["","67405055005","DOXYCYCL ","TAB 100MG","28","Select","Select",""],["","54418325","DEXAMETHASON ","TAB 2MG","15","Select","Select",""],["","27241000350","RISPERIDONE ","TAB 0.5MG","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","27","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","62037071001","POT  CL MICRO","TAB 10MEQ CR","30","Select","Select",""],["","555007101","ISONIAZID ","TAB 300MG","30","Select","Select",""],["","53489014605","SMZ\/TMP ","800-160","20","Select","Select",""],["","378797052","IPRATROPIUM ","0.02%INH","62.5","Select","Select",""],["","55111059705","MEMANTINE ","HCL 10MG","30","Select","Select",""],["","3089321","ELIQUIS ","2.5MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}