{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIE E JACKSON","gend":1,"add":"367  CHERRYHILL RD","city":"ROANOKE","state":"VA","zip":240179999,"dob":"1936-07-01","age":"","mstatus":"","insh":11008329,"cliId":"8CG3JH5XY73","pno":5409778932,"cno":"","email":"","ename":"","eno":"","pphy":"BELL, VICTOR HOLLOWAY","ppno":5403620360,"pcpadd":"3716 Melrose Ave NW","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240172716,"pcpcounty":"","pcpid":"P0060152","pcpname":"NEW HORIZONS HEALTH CARE","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"ROANOKE\/ALLEGHANY","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":["I46.9","J96.01","J44.1","E11.9","I10","Z86.73","Z86.69","M19.90","G62.9","R53.1","R50.9","I50.31","E87.0","G40.909","F05","M62.81","E08.40","H54.1213","G31.84","R26.81","R13.12","I69.320","M15.8","G90.09","G40.89","J96.21","M25.551","M25.552","M25.561","M25.461","M79.89","R41.89","F32.9","F31.9","G47.00","I63.9","I21.9","N18.3","N17.9","E11.42","H54.8","H91.8X3","E11.22","J45.30","M62.00","M25.50","M79.10","R70.0","N18.9","E11.40","R41.82","Z74.3","R46.4","G45.9","G40.309","I50.32","J44.9","I50.30","M67.01","B35.1","M67.02","M21.6X1","M21.6X2","L85.3","Z74.09","R73.03","Z68.41","D64.9","E78.2","Z23","J06.9","R05","R06.02","I13.0","I50.9","I25.10","F03.90","E78.5","Z87.891","Z20.828","Z79.82","N28.9","J45.901","I51.7","I70.0","I77.1","R09.02","I21.A1","B49","E87.2","E66.01","I16.0","Z11.59","R41.0","I45.10","R00.0","R78.81","R16.0","E86.0","R53.81","Z79.51","R27.9","I21.4","F02.80","H91.90","Z68.38","K29.70","R07.89","I44.0","J96.22","I67.2","I65.23","J96.00","Z99.11","Z87.898","K44.9","R06.89","R31.9","R09.89","Z46.82","J96.90","J81.1","J94.8","I11.0","E11.649","I49.9","Z68.39","Z20.822","J20.9","J44.0","N18.30","R07.9","I08.3","I77.810","R77.8","J18.9"],"date":["2020-01-18","2020-12-01","2021-07-01","2021-05-08","2021-05-08","2021-05-02","2020-01-18","2021-05-02","2020-01-18","2021-05-08","2020-01-06","2020-01-18","2020-01-18","2021-05-05","2020-01-21","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2020-03-20","2020-02-01","2020-02-01","2020-03-20","2020-02-01","2020-02-01","2020-02-01","2020-03-25","2020-01-22","2020-01-27","2020-01-27","2020-01-27","2020-05-22","2020-02-18","2020-02-18","2020-05-22","2020-02-07","2020-02-07","2020-05-20","2020-12-01","2020-06-11","2020-05-20","2020-05-20","2021-05-05","2020-05-20","2020-03-20","2021-04-07","2020-05-22","2020-05-22","2021-05-08","2021-04-07","2020-12-01","2021-05-05","2020-04-13","2020-04-14","2020-04-14","2021-05-02","2021-05-05","2021-05-05","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2019-12-01","2020-09-18","2020-10-28","2019-10-22","2021-04-07","2019-10-22","2020-10-22","2020-10-22","2021-05-05","2021-05-05","2020-11-19","2021-06-15","2020-11-18","2021-05-05","2021-05-05","2020-11-18","2021-05-02","2019-10-27","2020-11-18","2019-12-13","2019-12-13","2019-10-27","2020-11-18","2020-11-23","2021-05-02","2020-11-19","2021-05-02","2020-11-19","2020-11-18","2020-11-19","2021-05-05","2020-11-25","2020-11-21","2020-11-21","2020-12-01","2020-11-27","2021-05-05","2020-12-02","2021-05-08","2021-05-02","2021-05-05","2021-06-15","2019-12-07","2019-12-07","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-20","2019-12-22","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-20","2019-12-25","2019-12-23","2019-12-23","2019-12-23","2020-11-20","2021-04-07","2021-05-05","2021-05-08","2021-05-08","2021-05-05","2021-05-05","2021-05-06","2021-05-06","2021-05-06","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":[["","23155000910","HYDROCHLOROT","TAB 50MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","93010901","CARBAMAZEPIN","TAB 200MG","","Select","Select",""],["","378064110","PREDNISONE","TAB 10MG","","Select","Select",""],["","13668010390","DONEPEZIL","TAB 10MG","","Select","Select",""],["","70436000203","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","378932132","WIXELA INHUB","AER 250\/50","","Select","Select",""],["","378967130","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","51672127406","BETAMETH DIP","CRE 0.0005","","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","68462040560","ASA\/DIPYRIDA","CAP 25-200MG","","Select","Select",""],["","50742061610","METOPROL SUC","TAB 50MG ER","","Select","Select",""],["","24208048510","DORZOLAMIDE","SOL 2% OP","","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","68180046409","SIMVASTATIN","TAB 40MG","","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","","Select","Select",""],["","10631000830","KAPSPARGO","CAP 25MG","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","832532411","POT CL MICRO","TAB 10MEQ ER","","Select","Select",""],["","61314003002","DORZOL\/TIMOL","SOL 22.3-6.8","","Select","Select",""],["","228212750","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","8290320109","BD PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","","Select","Select",""],["","65862020390","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","23155000910","HYDROCHLOROT ","TAB 50MG","90","Select","Select",""],["","378064110","PREDNISONE ","TAB 10MG","14","Select","Select",""],["","93010901","CARBAMAZEPIN ","TAB 200MG","360","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","378932132","WIXELA ","AER 250\/50","60","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","23155000301","HYDRALAZINE ","TAB 50MG","28","Select","Select",""],["","13668010390","DONEPEZIL ","TAB 10MG","30","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","378967130","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","68462040560","ASA\/DIPYRIDA ","CAP 25-200MG","180","Select","Select",""],["","70377000415","SIMVASTATIN ","TAB 40MG","90","Select","Select",""],["","50742061610","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","51672127406","BETAMETH ","CRE 0.0005","45","Select","Select",""],["","832532411","POT  CL MICRO","TAB 10MEQ ER","2","Select","Select",""],["","10631000830","KAPSPARGO ","CAP 25MG","12","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","228212750","CLONIDINE ","TAB 0.1MG","2","Select","Select",""],["","24208048510","DORZOLAMIDE ","SOL 2% OP","10","Select","Select",""],["","61314003002","DORZOL\/TIMOL ","SOL 22.3-6.8","10","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","90","Select","Select",""],["","8290320109","BD  PEN NEEDL","MIS 31GX8MM","200","Select","Select",""],["","65862053650","LEVOFLOXACIN ","250MG","8","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":""}]}]}