{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS E KAST","gend":0,"add":"152OAK VIEW LAND NE  ","city":"RINER ","state":"VA","zip":"24149-3505","dob":"1964-04-18","age":"","mstatus":"","insh":11008952,"cliId":"6XE5Y09VT56","pno":5407894953,"cno":5407894953,"email":"","ename":"","eno":"","pphy":"MENEZES, ROBERT C ","ppno":2767284311,"pcpadd":"702 Pine St","pcpcity":"Hillsville  ","pcpstate":"VA","pcpzip":243431405,"pcpcounty":"","pcpid":"P9059115","pcpname":"TWIN COUNTY FAMILY CARE CENTER OF HILLSVILLE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"152OAK VIEW LAND NE  ","madd2":"","madd3":"","mcity":"RINER ","mstate":"VA","mzip":"24149-3505","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E78.5","R42","Z87.898","G40.909","Z95.0","D50.9","R10.12","K92.1","R56.9","G93.40","G40.009","D64.9","I49.5","F09","S06.9X9S","I95.1","K20.9","K29.70","K29.50","K21.0","H91.92","I10","Z87.891","Z45.018","B37.0","F17.220","H70.12","H61.22","Z00.00","Z23","N32.81","R10.84","R50.9","U07.1","R10.9","K57.30","Z86.14","F17.290","Z87.820","R26.81","R27.0","R26.0","R26.89","M62.81","G98.8","H54.42A5","H71.92","Z79.52","I47.2","R35.1","R39.15","E66.9","Z20.828","Z20.822","S06.9X9D","R07.9","R06.02"],"date":["2021-11-03","2021-03-09","2020-06-24","2021-06-01","2021-11-03","2020-05-14","2020-01-15","2020-04-02","2021-06-22","2021-06-29","2021-06-29","2021-06-29","2020-10-19","2020-02-11","2021-06-01","2021-06-01","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2021-08-18","2020-05-14","2020-05-14","2021-08-26","2021-08-26","2020-10-19","2021-06-01","2021-08-04","2021-01-11","2021-01-11","2021-02-05","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-11-19","2021-02-05","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2021-07-05","2021-07-05","2021-06-01","2021-11-15","2021-11-03"],"priorHcc":[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":[["","93010901","CARBAMAZEPIN","TAB 200MG","","Select","Select",""],["","115703301","FLUDROCORT","TAB 0.1MG","","Select","Select",""],["","57237010601","DIVALPROEX","TAB 125MG DR","","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","","Select","Select",""],["","70069013101","TOBRAMYCIN","SOL 0.3% OP","","Select","Select",""],["","574402235","BACITRACIN","OIN OP","","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","61314063305","GENTAMICIN","SOL 0.3% OP","","Select","Select",""],["","70461041910","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","93010901","CARBAMAZEPIN ","TAB 200MG","120","Select","Select",""],["","29300013801","DIVALPROEX ","TAB 125MG DR","90","Select","Select",""],["","115703301","FLUDROCORT ","TAB 0.1MG","60","Select","Select",""],["","68462038730","SOLIFENACIN ","TAB 10MG","30","Select","Select",""],["","70069013101","TOBRAMYCIN ","SOL 0.3% OP","5","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","CRE 0.01","60","Select","Select",""],["","61314063305","GENTAMICIN ","SOL 0.3% OP","5","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50MCG","1","Select","Select",""],["","574402235","BACITRACIN ","OIN OP","3.5","Select","Select",""],["","70461041910","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","57237003105","AMOXICILLIN ","500MG","30","Select","Select",""],["","57237003105","AMOXICILLIN","500MG","30","Select","Select",""],["","70461041910","FLUCLVX","2019-20","0.5","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","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","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}