{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN C DOOLEY","gend":1,"add":"329 FORREST GLEN CT APT 6  ","city":"STRASBURG","state":"VA","zip":"22657-9998","dob":"1954-01-02","age":"","mstatus":"","insh":11012336,"cliId":"2JD9J44CF45","pno":5404652540,"cno":5404652540,"email":"","ename":"","eno":"","pphy":"HOLTHUS, THOMAS E ","ppno":5404653751,"pcpadd":"33674 Old Valley Pike","pcpcity":"Strasburg","pcpstate":"VA","pcpzip":226573704,"pcpcounty":"","pcpid":"P0137582","pcpname":"VALLEY HEALTH SHENANDOAH MEMORIAL HOSPITAL SHENAND","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"329 FORREST GLEN CT APT 6  ","madd2":"","madd3":"","mcity":"STRASBURG","mstate":"VA","mzip":"22657-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","G47.30","M60.80","E11.9","M51.34","Z51.81","Z79.01","Z86.718","G30.9","N18.6","F41.9","M48.00","F33.3","R52","G89.29","N39.46","R26.2","I82.90","E78.5","Z79.4","Z86.39","G47.33","E21.3","K76.0","E66.01","Z68.41","Z79.84","G89.4","M85.80","M54.41","Z79.891","M19.011","M31.0","M89.49","M75.81","G60.9","Z23","E55.9","E03.9","G62.9","M54.5","Z87.891","M53.9","L98.491","Z99.89","R26.81","Z91.81","Z87.828","M19.90","Z79.82","Z79.899","R42","M51.36","M41.9","M85.861","M17.11","M23.41","M25.861","M25.461","M76.51","M85.89","M79.651","R53.81","Z74.09","S31.109D","L08.9","E11.42","M79.7","M21.371","F32.9","K21.9","Z38.41","L95.8","F41.8","E11.65","Z71.3","M51.26","S31.109S","X58.XXXS","E13.40","F43.21","R93.2","R93.89","K74.60"],"date":["2021-11-10","2021-09-08","2021-09-08","2021-11-10","2020-09-06","2021-10-15","2021-10-15","2021-06-23","2020-09-06","2020-09-06","2021-02-21","2020-05-26","2020-05-26","2021-09-29","2021-11-10","2021-11-28","2021-11-28","2021-10-15","2021-11-10","2021-11-10","2020-06-09","2021-10-15","2021-11-10","2021-11-10","2021-11-08","2021-07-07","2020-06-17","2021-09-29","2021-09-08","2020-09-16","2020-09-16","2020-10-07","2021-09-10","2021-11-10","2021-09-10","2021-08-27","2021-11-10","2021-11-10","2021-11-10","2020-11-12","2021-06-30","2020-06-06","2020-12-16","2021-07-01","2021-11-28","2021-11-28","2021-11-28","2020-06-06","2021-06-23","2021-02-21","2020-06-06","2020-06-06","2021-09-10","2021-09-10","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-03-03","2021-03-03","2021-07-07","2021-05-03","2021-11-10","2021-11-10","2021-02-21","2021-06-23","2021-02-21","2021-02-21","2021-06-23","2021-01-22","2021-07-01","2021-07-07","2021-07-07","2021-10-15","2021-09-10","2021-10-15","2021-10-15","2021-11-22","2021-11-08","2021-10-15","2021-10-15","2021-10-15"],"priorHcc":[null,"","",null,"",null,null,"","","","","","","",null,null,null,null,null,null,"","",null,null,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":[["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","591079501","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","69238148501","ERYTHROMYCIN","TAB 500MG BS","","Select","Select",""],["","65862029630","ROSUVASTATIN","TAB 40MG","","Select","Select",""],["","469260230","MYRBETRIQ","TAB 50MG","","Select","Select",""],["","57237022030","PIOGLITAZONE","TAB 30MG","","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","51672402901","WARFARIN","TAB 2.5MG","","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","","Select","Select",""],["","378395205","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","193731221","CONTOUR","TES NEXT","","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","","Select","Select",""],["","555057202","METHOTREXATE","TAB 2.5MG","","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","","Select","Select",""],["","51672128901","NYSTATIN","CRE 100000","","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","","Select","Select",""],["","143980305","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","93506201","HYDROXYZ HCL","TAB 50MG","","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","30","Select","Select",""],["","591079501","DICYCLOMINE ","TAB 20MG","360","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","180","Select","Select",""],["","65862029630","ROSUVASTATIN ","TAB 40MG","90","Select","Select",""],["","57237022030","PIOGLITAZONE ","TAB 30MG","90","Select","Select",""],["","469260230","MYRBETRIQ ","TAB 50MG","30","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","30","Select","Select",""],["","69238148501","ERYTHROMYCIN ","TAB 500MG BS","20","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","45","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","15","Select","Select",""],["","51672402901","WARFARIN ","TAB 2.5MG","90","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","360","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","270","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","90","Select","Select",""],["","378395205","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","65702071210","ACCU-CHEK ","TES GUIDE","200","Select","Select",""],["","59651018201","METHOTREXATE ","TAB 2.5MG","24","Select","Select",""],["","193737701","CONTOUR ","KIT NEXT","1","Select","Select",""],["","59746012106","MECLIZINE ","TAB 25MG","30","Select","Select",""],["","65702073110","ACCU-CHECK ","KIT GUIDE ME","1","Select","Select",""],["","50924097110","SOFTCLIX ","MIS LANCETS","600","Select","Select",""],["","65702028810","FASTCLIX ","MIS LANCETS","612","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","28","Select","Select",""],["","93314705","CEPHALEXIN ","500MG","40","Select","Select",""],["","70954005820","PREDNISONE ","5MG","60","Select","Select",""],["","93506201","HYDROXYZ ","50MG","90","Select","Select",""],["","143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","28","Select","Select",""],["","70954005820","PREDNISONE","5MG","60","Select","Select",""],["","65162062711","TRAMADOL","50MG","180","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","40","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","45","Select","Select",""],["","57237005920","CEFUROXIME","500MG","28","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","00093506201","HYDROXYZ","50MG","90","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","57237005920","CEFUROXIME ","TAB 500MG","28","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","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":""}]}]}