{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REX LIVESAY","gend":0,"add":"1797 VALLEY SPRINGS RD","city":"ROSE HILL                     ","state":"VA","zip":"24281-9998","dob":"1947-02-07","age":"","mstatus":"","insh":11009692,"cliId":"2CE8TU9NE35","pno":2764454539,"cno":2764454539,"email":"","ename":"","eno":"","pphy":"ECHEVERRIA, JOSE M","ppno":6065734520,"pcpadd":"37 Ball Park Rd,","pcpcity":"Harlan                        ","pcpstate":"KY","pcpzip":408311701,"pcpcounty":"","pcpid":"P0130544","pcpname":"ARH PENNINGTON GAP CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1797 VALLEY SPRINGS RD","madd2":"","madd3":"","mcity":"ROSE HILL                     ","mstate":"VA","mzip":"24281-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I71.4","I72.3","I70.1","I10","F17.210","N18.9","I65.23","I65.21","I12.9","Z79.02","Z79.82","Z79.899","E11.51","C67.9","Z99.81","J44.9","M10.9","E78.5","K21.9","Z85.51","I65.22","E11.9","Z68.31","N18.4","N25.0","N18.3","C68.9","E11.8","E55.9","R53.83","Z68.32","I11.9","E78.2","N40.1","N13.8","H66.002","E78.00","I70.8","E11.22","Z68.33","D49.4","R31.9","C67.4","D63.1","D63.0","Z11.59","Z79.84","C68.8","F41.9","Z51.81","Z00.01","R73.09","Z28.21","Z01.818","R77.8","J44.1","N17.9","N18.30","E87.6","R42","R53.1","E86.0","J18.9","I48.91","I50.9","D64.9","Z20.828","Z72.0","I21.4","J44.0","J96.11","I13.0","Z68.36","R79.89","R07.9","J43.8","R91.8","R60.9","E87.1","I11.0","Z68.34","I73.9","I25.2","Z68.35","J01.00","J43.9","R93.89","Z71.6","Z12.2","R94.2","G47.33","E66.9","J96.21","R04.2","Z20.822","Z68.37","R06.89","J22","Z79.4","I25.10","Z87.01","G47.30"],"date":["2021-07-20","2020-05-05","2020-01-02","2021-06-22","2021-06-22","2021-04-27","2020-01-03","2020-05-05","2021-06-17","2020-12-30","2020-06-27","2021-06-22","2020-12-30","2020-10-08","2021-05-27","2021-07-23","2021-05-27","2021-06-22","2020-01-07","2021-05-27","2020-01-07","2021-07-20","2021-01-22","2021-07-20","2021-06-17","2020-09-02","2021-04-27","2021-01-22","2021-06-22","2020-05-29","2020-03-02","2020-10-02","2021-05-27","2020-09-04","2020-07-06","2020-04-27","2020-05-05","2020-05-05","2021-06-17","2020-09-30","2021-01-19","2020-06-16","2020-06-27","2020-06-27","2020-06-27","2020-10-05","2020-06-27","2020-08-07","2020-09-04","2021-04-21","2020-09-04","2020-09-04","2020-09-30","2020-10-05","2021-01-04","2021-05-27","2021-01-04","2021-04-27","2021-01-28","2021-01-25","2021-05-27","2021-01-28","2021-01-28","2021-05-27","2021-04-27","2021-07-20","2020-12-28","2020-12-27","2020-12-30","2021-05-27","2021-03-08","2021-05-27","2021-05-27","2020-12-28","2020-12-30","2020-12-31","2020-12-31","2021-01-13","2021-01-22","2021-07-20","2021-01-28","2021-01-28","2021-06-22","2021-03-24","2021-03-24","2020-10-07","2021-03-08","2020-10-07","2020-10-07","2021-03-08","2021-07-01","2021-03-08","2020-12-30","2020-12-30","2020-12-30","2021-07-20","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-07-20"],"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":[["","68382009405","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","98302000198","COMFORT EZ","MIS 31GX8MM","","Select","Select",""],["","55111072910","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","59651026905","GLIPIZIDE ER","TAB 5MG","","Select","Select",""],["","8290326895","BD SWAB REG","PAD SNGL USE","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","24979001012","NIFEDIPINE","TAB 60MG ER","","Select","Select",""],["","60505132305","PRAVASTATIN","TAB 80MG","","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","65702071110","ACCU-CHEK","TES GUIDE","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","","Select","Select",""],["","185505001","METOLAZONE","TAB 2.5MG","","Select","Select",""],["","310111030","LOKELMA","PAK 10GM","","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","781196260","CLARITHROMYC","TAB 500MG","","Select","Select",""],["","47781022905","OXYCOD\/APAP","TAB 7.5-325","","Select","Select",""],["","173088710","TRELEGY","AER ELLIPTA","","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","16729013416","ALLOPURINOL ","TAB 100MG","60","Select","Select",""],["","173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","68382009405","CARVEDILOL ","TAB 12.5MG","60","Select","Select",""],["","16729021816","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","59651026905","GLIPIZIDE ","TAB 5MG","30","Select","Select",""],["","8290326895","BD ","PAD SNGL USE","100","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","15","Select","Select",""],["","98302000198","COMFORT ","MIS 31GX8MM","100","Select","Select",""],["","24979001012","NIFEDIPINE ","TAB 60MG ER","30","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","60505132305","PRAVASTATIN ","TAB 80MG","30","Select","Select",""],["","65702028810","FASTCLIX ","MIS LANCETS","102","Select","Select",""],["","173068220","VENTOLIN ","AER ","18","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","65702071110","ACCU-CHEK ","TES GUIDE","50","Select","Select",""],["","53885027150","ONETOUCH ","TES VERIO","50","Select","Select",""],["","173088710","TRELEGY ","AER ELLIPTA","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","310111030","LOKELMA ","PAK 10GM","30","Select","Select",""],["","57237009960","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","185505001","METOLAZONE ","TAB 2.5MG","15","Select","Select",""],["","781196260","CLARITHROMYC ","TAB 500MG","20","Select","Select",""],["","51224002218","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","33342002108","LEVOFLOXACIN ","250MG","5","Select","Select",""],["","47781022905","OXYCOD\/APAP ","7.5-325","6","Select","Select",""],["","65702073110","ACCU-CHECK ","GUIDE ME","1","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","15","Select","Select",""],["","98302000198","COMFORT","31GX8MM","100","Select","Select",""],["","59651026905","GLIPIZIDE","5MG","30","Select","Select",""],["","08290326895","BD","SNGL USE","100","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","59310057922","PROAIR","","8.5","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":[[["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":""}]}]}