{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHEN R RUBLE","gend":0,"add":"173 RUEBUCK RD ","city":"CLEAR BROOK ","state":"VA","zip":"22624-9998","dob":"1980-11-13","age":"","mstatus":"","insh":11013125,"cliId":"4R32QE1AP13","pno":5402470350,"cno":5402470350,"email":"","ename":"","eno":"","pphy":"AGYEIWAAH, MAVIS A","ppno":5405365400,"pcpadd":"5060 Valley View Blvd NW","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240122038,"pcpcounty":"","pcpid":"P0150882","pcpname":"VALLEY HEALTH WINCHESTER FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 251  ","madd2":"","madd3":"","mcity":"CLEAR BROOK ","mstate":"VA","mzip":"22624-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N39.0","R39.81","E66.01","F84.0","R26.89","R31.9","J32.0","J32.2","J32.1","N39.41","N39.44","R31.0","F31.81","J34.2","J32.4","J98.11","Z01.818","J43.2","J32.9","E11.9","R35.0","Q07.00","Z88.1","Z20.828","Z45.2","Z16.12","B96.20","F84.5","F32.9","F31.9","K21.9","Z00.00","Z86.69","G43.009","E53.8","G47.33","R32","R82.90","G93.5","E78.5","I10","Z99.89","N20.0","R30.0","K76.0","R11.2","Z68.42","G47.00","E55.9","F79","G43.709","L03.90","R31.29","L03.311","L90.6","S91.101A","W10.8XXA","M79.671","F78","G47.11","L02.211","N28.1","R16.0","K80.20","N32.89","Z79.899"],"date":["2021-11-08","2021-11-03","2021-11-24","2021-11-03","2021-11-03","2021-11-03","2020-07-08","2020-06-29","2020-06-24","2021-11-08","2021-11-08","2021-11-08","2021-11-24","2020-06-29","2020-06-18","2020-06-19","2020-06-20","2020-06-24","2020-06-24","2021-09-20","2020-09-23","2020-07-29","2020-08-25","2020-07-21","2020-07-29","2020-08-17","2020-08-18","2021-09-20","2020-07-29","2020-07-29","2020-07-29","2020-08-11","2021-03-25","2021-03-25","2021-09-27","2021-10-11","2020-08-25","2020-08-25","2020-08-25","2021-09-20","2021-09-20","2020-11-03","2020-11-30","2021-11-04","2020-12-08","2020-12-08","2021-09-20","2021-03-25","2021-09-27","2021-03-25","2021-03-25","2021-05-11","2021-08-11","2021-07-30","2021-07-30","2021-08-04","2021-08-04","2021-08-04","2021-09-20","2021-09-27","2021-10-19","2021-11-23","2021-11-23","2021-11-23","2021-11-19","2021-11-24"],"priorHcc":[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":[["","43547034306","RISPERIDONE","TAB 3MG","","Select","Select",""],["","68001033203","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","70377000415","SIMVASTATIN","TAB 40MG","","Select","Select",""],["","23155011601","GLIP\/METFORM","TAB 2.5-500M","","Select","Select",""],["","68001032600","DESMOPRESSIN","TAB 0.2MG","","Select","Select",""],["","43598051010","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","65862008101","GLYB\/METFORM","TAB 2.5-500","","Select","Select",""],["","33342005607","PIOGLITAZONE","TAB 45MG","","Select","Select",""],["","378306605","FENOFIBRATE","TAB 145MG","","Select","Select",""],["","16729020216","BUSPIRONE","TAB 10MG","","Select","Select",""],["","62332014271","CELECOXIB","CAP 200MG","","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","603243821","BENZTROPINE","TAB 1MG","","Select","Select",""],["","228278011","PROPRANOLOL","CAP 120MG ER","","Select","Select",""],["","378034501","DIAZEPAM","TAB 5MG","","Select","Select",""],["","68382009906","PAROXETINE","TAB 30MG","","Select","Select",""],["","406048401","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","71930001912","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","406889101","AMPHETAMINE","TAB 5MG","","Select","Select",""],["","56151014701","TRUPLUS LANC","MIS 33G","","Select","Select",""],["","68001042300","NITROFURANTN","CAP 100MG","","Select","Select",""],["","51224002230","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","49281063315","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","56151147002","TRUE METRIX","KIT METER","","Select","Select",""],["","60913000601","ALCOHOL PREP","PAD ","","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","228278011","PROPRANOLOL ","CAP 120MG ER","30","Select","Select",""],["","16729020216","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","172392680","DIAZEPAM ","TAB 5MG","60","Select","Select",""],["","68001032600","DESMOPRESSIN ","TAB 0.2MG","60","Select","Select",""],["","68001033203","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","43547034306","RISPERIDONE ","TAB 3MG","90","Select","Select",""],["","33342005607","PIOGLITAZONE ","TAB 45MG","30","Select","Select",""],["","70377000415","SIMVASTATIN ","TAB 40MG","30","Select","Select",""],["","62332014271","CELECOXIB ","CAP 200MG","30","Select","Select",""],["","69097045805","FENOFIBRATE ","TAB 145MG","30","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","60","Select","Select",""],["","43598051010","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","23155011601","GLIP\/METFORM ","TAB 2.5-500M","60","Select","Select",""],["","68382009906","PAROXETINE ","TAB 30MG","15","Select","Select",""],["","603243821","BENZTROPINE ","TAB 1MG","60","Select","Select",""],["","65862008101","GLYB\/METFORM ","TAB 2.5-500","60","Select","Select",""],["","406889101","AMPHETAMINE ","TAB 5MG","30","Select","Select",""],["","71930001912","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","56151014701","TRUPLUS ","MIS 33G","100","Select","Select",""],["","56151146004","TRUE ","TES GLUCOSE","100","Select","Select",""],["","60913000601","ALCOHOL ","PAD ","200","Select","Select",""],["","406048401","APAP\/CODEINE ","TAB 300-30MG","12","Select","Select",""],["","68001042300","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","72578000105","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","60","Select","Select",""],["","51224002230","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","49281063315","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","781261305","AMOXICILLIN ","500MG","15","Select","Select",""],["","43598051010","ESOMEPRA","40MG DR","30","Select","Select",""],["","56151146004","TRUE","GLUCOSE","100","Select","Select",""],["","60913000601","ALCOHOL","","200","Select","Select",""],["","56151014701","TRUPLUS","33G","100","Select","Select",""],["","49281063315","FLUZONE","2020-21","0.5","Select","Select",""],["","72578000105","DOXYCYCL","100MG","14","Select","Select",""],["","45802006435","TRIAMCINOLON","0.001","60","Select","Select",""],["","00406889101","AMPHET\/DEXTR","5MG","30","Select","Select",""],["","00406889101","AMPHET\/DEXTR ","TAB 5MG","30","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","",""],["No","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":""}]}]}