{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDY C WOLFORD","gend":1,"add":"4821 PANTHER RIDGE ROAD ","city":"GRUNDY","state":"VA","zip":"24614-9998","dob":"1963-06-18","age":"","mstatus":"","insh":11008769,"cliId":"8KP3U64NH76","pno":2762597492,"cno":2762597492,"email":"","ename":"","eno":"","pphy":"SUTHERLAND, JOSHUA P ","ppno":2769357515,"pcpadd":"20886 Riverside Dr","pcpcity":"Grundy","pcpstate":"VA","pcpzip":246149597,"pcpcounty":"","pcpid":"P9307487","pcpname":"RIVERSIDE MEDICAL CLINIC INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 201  ","madd2":"","madd3":"","mcity":"PAYNESVILLE ","mstate":"WV","mzip":"24873-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M72.2","M79.671","M79.672","H52.03","H52.4","H04.123","H40.033","H25.13","M48.07","G89.4","M54.16","M51.36","M47.816","M47.812","Z79.899","N39.0","M51.06","M54.30","R10.2","N95.0","E89.40","N76.1","R30.0","G47.33","M53.3","M48.02","M79.7","E03.9","Z12.31","E78.2","R53.81","E16.2","J06.9","R05","R50.9","R11.0","J34.2","J34.3","R09.81","D37.02","K14.0","K13.6","L03.115","J01.00","J02.9","I10","E03.8","M51.16","M47.26","M50.00","E04.1","M12.211","M54.12","M54.2","M25.511","R73.09","E11.9","L98.9","R53.83","K21.9","E78.5","M25.50","E55.9","M54.5","M54.6","J30.9","J18.9","M54.41","E87.6","Z51.81","G89.29","M51.26","R25.2","M48.061","Z79.891","K21.00","R13.10","Z87.891","E66.01","Z68.41","M47.16","M54.50","M50.21","R10.9","E06.3","R05.9","R06.02"],"date":["2020-02-26","2020-09-09","2020-02-05","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2021-08-11","2021-08-11","2021-08-11","2021-07-06","2021-11-15","2020-09-15","2021-10-18","2020-02-20","2021-11-10","2021-11-10","2020-02-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2021-07-12","2020-06-15","2021-04-16","2021-07-30","2021-09-10","2020-08-03","2020-08-05","2021-04-08","2020-08-05","2021-01-18","2021-06-01","2020-10-07","2019-11-05","2019-11-18","2019-11-18","2019-11-12","2019-11-18","2019-11-18","2019-11-18","2019-12-07","2019-12-30","2021-06-01","2021-11-10","2021-01-25","2021-04-12","2021-04-12","2021-02-24","2021-09-15","2021-02-24","2021-07-22","2021-11-10","2021-02-24","2021-04-08","2021-04-08","2021-04-08","2021-07-30","2021-04-08","2021-04-08","2021-04-08","2021-07-30","2021-09-30","2021-07-30","2021-05-07","2021-06-01","2021-08-11","2021-07-30","2021-08-09","2021-08-11","2021-11-15","2021-07-30","2021-11-15","2021-08-09","2021-09-08","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-10-18","2021-11-10","2021-11-15","2021-11-10","2021-10-18","2021-11-22","2021-11-22"],"priorHcc":["","","","","","","","","","","","",null,"",null,"",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","",null,"","","","","","","","","","","","","","","","","",null,"",null,"","","","","","",null,null,null,null,null,null,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":[["","406851501","OXYCODONE","TAB 15MG","","Select","Select",""],["","59011041510","OXYCONTIN","TAB 15MG CR","","Select","Select",""],["","62332013330","OLMESA MEDOX","TAB 40MG","","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","","Select","Select",""],["","68180029606","DULOXETINE","CAP 60MG","","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","115151866","ESTRADIOL","CRE 0.0001","","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","93031805","DILTIAZEM","TAB 30MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","378668977","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","","Select","Select",""],["","69238183501","LEVOTHYROXIN","TAB 112MCG","","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","591505221","PREDNISONE","PAK 5MG","","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","70752010212","ALBUTEROL","SYP 2MG\/5ML","","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","","Select","Select",""],["","93354143","ESTRADIOL 0.0","0.01 CREAM","","Select","Select",""],["","781808926","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","68180029606","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","59011041510","OXYCONTIN ","TAB 15MG CR","60","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","406851501","OXYCODONE ","TAB 15MG","90","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","62332013330","OLMESA ","TAB 40MG","90","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","240","Select","Select",""],["","781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","115151866","ESTRADIOL ","CRE 0.0001","42.5","Select","Select",""],["","93031805","DILTIAZEM ","TAB 30MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","8","Select","Select",""],["","591505221","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","378668977","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","69238183501","LEVOTHYROXIN ","TAB 112MCG","30","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","375","Select","Select",""],["","143980305","DOXYCYCL ","100MG","28","Select","Select",""],["","781751687","BUDESONIDE ","0.5MG\/2","120","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20","Select","Select",""],["","00143980305","DOXYCYCL","100MG","28","Select","Select",""],["","00781751687","BUDESONIDE","0.5MG\/2","120","Select","Select",""],["","62332013330","OLMESA","40MG","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","59310058020","PROAIR ","AER ","1","Select","Select",""],["","00185041501","BUPROPION ","TAB 150MG SR","180","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":""}]}]}