{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LOIS A SMITH","gend":1,"add":"101 MADISON LANE","city":"LURAY                         ","state":"VA","zip":"22835-1669","dob":"1955-01-22","age":"","mstatus":"","insh":11009217,"cliId":"6VF8RE8HP54","pno":5408606589,"cno":7578605353,"email":"","ename":"","eno":"","pphy":"BALTUSNIK, PETER G                                          ","ppno":5407434561,"pcpadd":"200 Memorial Dr,","pcpcity":"Luray                         ","pcpstate":"VA","pcpzip":228351000,"pcpcounty":"","pcpid":"P0146862","pcpname":"PAGE MULTI SPECIALTY CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"APARTMENT I66","add3":"","madd1":"101 MADISON LANE","madd2":"APARTMENT I66","madd3":"","mcity":"LURAY                         ","mstate":"VA","mzip":"22835-1669","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G89.29","M54.5","M54.2","M25.561","M25.562","M85.80","M54.16","M79.2","G25.81","Z51.81","F32.9","E11.49","Z79.4","M25.569","M25.50","J44.1","R05","J40","R07.89","R06.02","I10","J43.2","G45.9","I25.110","R39.81","F45.42","Z13.89","T50.901A","R22.0","L25.9","R60.0","T78.40XA","R22.1","G47.33","E11.9","H25.12","J20.9","K21.9","E78.5","R91.8","R07.9","R16.0","K76.0","N20.0","M25.512","E11.59","I25.119","J43.1","Z00.00","K76.9","I65.22","I51.7","Z85.3","N64.4","R92.8","I65.23","M16.12","M25.552","R94.5","Z87.09","G62.9","Z79.899","H52.13","H52.223","H52.4","Z96.1","E11.65","R53.1","R20.0","I67.2","R29.818","K57.30","S22.31XA","R10.9","X58.XXXA","Z79.891","K52.9","R10.13","L98.9","R21","L23.7","N94.9","Z01.411","M79.89","R11.2","R19.7","E78.2","Z13.0","Z13.29","R45.89","Z86.73","F43.20","F41.8","F41.9","F32.89"],"date":["2021-07-21","2021-07-21","2021-07-21","2020-01-14","2020-01-14","2021-07-21","2021-07-21","2020-01-14","2020-03-17","2021-07-21","2021-06-07","2020-04-08","2021-06-14","2021-07-21","2021-07-21","2020-07-16","2020-02-22","2020-02-22","2020-02-22","2020-07-16","2021-06-14","2020-04-08","2021-06-08","2020-04-08","2021-08-26","2021-07-21","2021-07-21","2020-06-08","2020-06-08","2020-06-08","2020-06-09","2020-06-09","2020-06-09","2020-06-25","2021-03-23","2020-08-12","2020-07-16","2020-07-16","2021-05-20","2020-07-16","2020-10-07","2020-09-04","2021-07-15","2021-05-20","2020-10-22","2021-06-14","2021-06-14","2021-06-08","2020-12-07","2020-12-07","2020-10-07","2020-10-07","2020-10-08","2020-10-08","2020-10-08","2021-02-26","2020-10-22","2020-10-22","2021-07-15","2021-02-08","2021-06-08","2021-06-25","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2021-05-21","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-06-25","2021-05-20","2021-06-14","2021-05-20","2021-05-21","2021-05-21","2021-05-24","2021-07-15","2021-05-24","2021-06-02","2021-06-02","2021-06-14","2021-06-08","2021-06-08","2021-06-14","2021-06-14","2021-06-07","2021-06-07","2021-06-07","2021-06-07"],"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":[["","13668000705","ZOLPIDEM","TAB 5MG","","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","43547026910","ROPINIROLE","TAB 0.5MG","","Select","Select",""],["","70436000203","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","60505384801","CELECOXIB","CAP 100MG","","Select","Select",""],["","6057761","JANUMET","TAB 50-1000","","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","64764075030","TRINTELLIX","TAB 20MG","","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","","Select","Select",""],["","65862020390","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","591565810","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","254100752","ALBUTEROL","AER HFA","","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","","Select","Select",""],["","597007541","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","45802093726","HYDROCORT","LOT 0.025","","Select","Select",""],["","53746011001","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","65162083809","VALSARTAN","TAB 80MG","","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","60505014101","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","64380076111","OMEGA-3-ACID","CAP 1GM","","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","65924007","DUREZOL","EMU 0.0005","","Select","Select",""],["","93598627","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","68180038909","FENOFIBRATE","TAB 145MG","","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","","Select","Select",""],["","65175007","ILEVRO","DRO 0.3% OP","","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","","Select","Select",""],["","60505384801","CELECOXIB ","CAP 100MG","56","Select","Select",""],["","65862052405","GABAPENTIN ","TAB 800MG","112","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","186037020","SYMBICORT ","AER 160-4.5","30.6","Select","Select",""],["","13668000705","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","76385011350","CARVEDILOL ","TAB 25MG","180","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","33","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","180","Select","Select",""],["","597015230","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","64764075030","TRINTELLIX ","TAB 20MG","30","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","43547026910","ROPINIROLE ","TAB 0.5MG","180","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","63","Select","Select",""],["","6057761","JANUMET ","TAB 50-1000","180","Select","Select",""],["","43386035801","HYDROCO\/APAP ","TAB 10-325MG","112","Select","Select",""],["","378064205","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","5","Select","Select",""],["","45802093726","HYDROCORT ","LOT 0.025","118","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","378827052","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","597007541","SPIRIVA ","CAP HANDIHLR","90","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","180","Select","Select",""],["","64380076111","OMEGA-3-ACID ","CAP 1GM","180","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","65162083809","VALSARTAN ","TAB 80MG","30","Select","Select",""],["","42858010401","OXYCOD\/APAP ","TAB 10-325MG","120","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","310737020","BUDES\/FORMOT ","AER 160-4.5","30.6","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","180","Select","Select",""],["","33342032915","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","180","Select","Select",""],["","65862041901","SMZ-TMP ","TAB 400-80MG","60","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","65924007","DUREZOL ","EMU 0.0005","5","Select","Select",""],["","93598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","60505056000","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","60","Select","Select",""],["","68180038909","FENOFIBRATE ","145MG","90","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","169633910","NOVOLOG ","FLEXPEN","15","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40","Select","Select",""],["","65175007","ILEVRO ","0.3% OP","1.7","Select","Select",""],["","10702005601","OXYCODONE ","10MG","84","Select","Select",""],["","00088221905","LANTUS","100\/ML","33","Select","Select",""],["","65862020390","LOSARTAN","100MG","30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","10702005601","OXYCODONE","10MG","112","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","40","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":""}]}]}