{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALVIN L SHEPHERD","gend":0,"add":"155 LEE ST  ","city":"BOWLING GREEN  ","state":"VA","zip":"22427-9998","dob":"1962-04-10","age":"","mstatus":"","insh":11009592,"cliId":"9RV2VP3PX83","pno":8045144190,"cno":8045144190,"email":"","ename":"","eno":"","pphy":"VALDES-DAPENA, ANTONIO E","ppno":8046335840,"pcpadd":"121 Courthouse Ln","pcpcity":"Bowling Green  ","pcpstate":"VA","pcpzip":224279336,"pcpcounty":"","pcpid":"P9443041","pcpname":"MWMG FAMILY INTERNAL MEDICINE BOWLING GREEN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"155 LEE ST  ","madd2":"","madd3":"","mcity":"BOWLING GREEN  ","mstate":"VA","mzip":"22427-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.59","I10","I50.22","I25.5","I11.0","I27.22","I50.9","E11.9","E78.5","G47.33","I25.10","I48.91","Z79.01","Z79.84","Z87.891","Z95.810","Z79.02","R06.00","M25.562","Z79.82","R52","R09.02","E78.2","E83.42","I48.0","E61.2","I42.0","I48.20","I48.11","E78.00","Z01.810","Z11.59","I50.20","K21.9","Z45.02","Z88.8","M25.551","M25.552","M79.10","M54.16","M54.41","M54.42","G57.93","G89.4","M54.17","M47.816","M47.817","M51.26","M51.27","M10.9","I48.92","I42.9","Z82.49","M79.672","M79.671","G89.29","M48.061","R20.2","R60.9","R53.81","Z23","Z12.11","M54.89","M77.31","M77.32","N28.9","M1A.0720","M1A.3720"],"date":["2021-11-10","2021-11-10","2021-09-20","2021-09-20","2021-09-01","2020-02-05","2021-09-01","2021-09-01","2021-09-01","2020-02-05","2020-06-11","2020-05-20","2020-05-20","2021-09-01","2021-02-20","2021-08-10","2021-02-20","2020-02-05","2020-02-09","2020-02-09","2021-02-20","2020-02-09","2020-02-12","2020-02-12","2021-04-27","2020-03-06","2021-08-10","2021-04-27","2020-04-21","2021-11-10","2021-08-10","2020-05-16","2020-05-20","2021-11-10","2021-08-10","2020-05-20","2020-07-23","2020-07-23","2020-07-23","2021-10-06","2021-01-05","2021-01-05","2021-10-06","2021-10-06","2021-10-06","2021-10-20","2021-10-20","2021-10-06","2021-10-06","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-09-08","2021-09-01","2020-10-22","2020-12-28","2021-09-01","2021-02-20","2021-09-01","2021-11-10","2021-08-10","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-11-10","2021-09-20"],"priorHcc":[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":[["","33332032001","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","185505001","METOLAZONE","TAB 2.5MG","","Select","Select",""],["","78065920","ENTRESTO","TAB 24-26MG","","Select","Select",""],["","54429931","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","378395105","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","55111046801","METOPROL SUC","TAB 100MG ER","","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","","Select","Select",""],["","67877056305","METFORMIN","TAB 1000MG","","Select","Select",""],["","65702072310","ACCU-CHEK","KIT AVIVA PL","","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","","Select","Select",""],["","378668877","PANTOPRAZOLE","TAB 20MG","","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","406048410","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","55111019605","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","406051205","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","67877058901","COLCHICINE","TAB 0.6MG","","Select","Select",""],["","68462032560","INDOMETHACIN","CAP 75MG ER","","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","78065920","ENTRESTO ","TAB 24-26MG","10","Select","Select",""],["","185505001","METOLAZONE ","TAB 2.5MG","12","Select","Select",""],["","68382056601","METOPROL ","TAB 100MG ER","180","Select","Select",""],["","378668877","PANTOPRAZOLE ","TAB 20MG","90","Select","Select",""],["","378718705","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","3089421","ELIQUIS ","TAB 5MG","180","Select","Select",""],["","67877058901","COLCHICINE ","TAB 0.6MG","90","Select","Select",""],["","55111019605","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","378395105","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","54429931","FUROSEMIDE ","TAB 40MG","270","Select","Select",""],["","65702072310","ACCU-CHEK ","KIT AVIVA PL","1","Select","Select",""],["","65702028810","FASTCLIX ","MIS LANCETS","204","Select","Select",""],["","53885000810","ONETOUCH ","MIS PLUS 33G","200","Select","Select",""],["","53885004401","ONE ","KIT VERIO FL","1","Select","Select",""],["","406048410","APAP\/CODEINE ","TAB 300-30MG","90","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","28","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","406051205","OXYCOD\/APAP ","5-325MG","60","Select","Select",""],["","68462032560","INDOMETHACIN ","75MG ER","12","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","68382056601","METOPROL","100MG ER","180","Select","Select",""],["","00378034505","DIAZEPAM","5MG","2","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","65162062711","TRAMADOL","50MG","28","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","29300034901","ALLOPURINOL","100MG","90","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","29300034901","ALLOPURINOL ","TAB 100MG","90","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00378034505","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","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":""}]}]}