{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LOIS CARTER","gend":1,"add":"416 SHAWNEE AVENUE E APT 7 ","city":"BIG STONE GAP  ","state":"VA","zip":"24219-9998","dob":"1963-11-27","age":"","mstatus":"","insh":11012376,"cliId":"6GH6G66MF49","pno":2762207148,"cno":2762207148,"email":"","ename":"","eno":"","pphy":"BASHAM, CHRISTOPHER M","ppno":2766790321,"pcpadd":"295 Wharton Ln NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"P9059214","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"416 SHAWNEE AVENUE E APT 7 ","madd2":"","madd3":"","mcity":"BIG STONE GAP  ","mstate":"VA","mzip":"24219-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R13.10","J44.9","E11.21","G25.0","Z79.899","R42","R25.1","R13.13","K21.9","I10","G44.011","R00.9","R00.0","J32.0","I67.82","R51","J32.9","J01.00","L73.9","N89.8","M17.11","M22.41","R35.0","Z23","M25.561","H91.93","H93.8X2","H61.21","H90.3","H93.12","H81.13","H81.11","M25.572","M62.81","M25.60","D44.7","H93.A2","N17.9","E83.42","E83.52","Z09","S83.206A","S83.206S","E78.00","M79.89","R20.0","G62.9","E66.3","Z71.3","Z71.89","E11.9","H25.13","H02.831","H02.834","H33.331","G62.89","Z68.41","Z01.812","Z01.818","K31.9","D64.9","K29.80","D50.9","K76.0","R63.4","J45.909","E11.51","E78.5","Z13.6","N93.9","R30.0","Z01.411","R31.29","R87.610","S30.814A","X58.XXXA","S39.94XA","R10.2","R30.9","Y07.03","T76.21XA","Z72.0","Z79.84","Z12.31","R82.71","F17.210","S93.401A","S83.8X1A","X50.1XXA","S99.911A","W01.0XXA","S83.91XA","R07.9","R22.41","W19.XXXA","S89.91XA","Z28.21","R10.9","K29.90","R18.8","R26.0","R26.81","E03.9","M54.50"],"date":["2020-11-02","2021-06-20","2021-09-21","2020-09-21","2021-05-12","2021-11-17","2021-09-21","2021-01-21","2021-10-08","2021-09-21","2020-07-07","2020-06-12","2020-06-12","2020-07-07","2020-07-07","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2021-11-10","2021-01-20","2021-03-22","2020-09-21","2020-09-21","2021-01-29","2020-09-21","2020-10-05","2020-10-05","2020-10-15","2020-11-17","2020-10-15","2020-10-15","2020-11-02","2020-11-02","2020-11-02","2020-11-13","2020-11-13","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-01-20","2021-01-29","2021-01-21","2021-02-12","2021-02-12","2021-10-08","2021-01-29","2021-01-29","2021-01-29","2021-06-20","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-22","2021-03-25","2021-03-25","2021-03-30","2021-10-08","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2020-12-29","2021-06-20","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-06-20","2021-06-16","2021-06-20","2021-11-17","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-11-10","2021-11-11"],"priorHcc":["","","","","",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":[["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","93716456","TOLTERODINE","CAP 4MG ER","","Select","Select",""],["","99073070822","FREESTYLE","TES LITE","","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","70461032003","FLUCLVX QUAD","INJ 2020-21","","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","70010049110","METFORMIN ","TAB 500MG ER","180","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","93716456","TOLTERODINE ","CAP 4MG ER","30","Select","Select",""],["","378021610","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","42","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","43598075201","BUPROPION ","TAB 150MG SR","180","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","180","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","99073070822","FREESTYLE TES LITE","LITE","50","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","00378180010","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","53746054401","PRIMIDONE","50MG","180","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0.5","Select","Select",""],["","68308015215","NYSTATIN ","POW 100000","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","53746054401","PRIMIDONE ","TAB 50MG","180","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0.5","Select","Select",""],["","00378180010","LEVOTHYROXIN ","TAB 25MCG","90","Select","Select",""],["","70436015301","POT  CHLORIDE","TAB 20MEQ ER","2","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":""}]}]}