{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON HURLEY","gend":1,"add":"C\/O DOROTHY GIBSON","city":"KINGSPORT","state":"TN","zip":"24266-4617","dob":"1955-10-25","age":"","mstatus":"","insh":11016920,"cliId":"7WA6EX3HJ65","pno":2763936756,"cno":4232395118,"email":"","ename":"","eno":"","pphy":"HARMAN, NICHOLAS","ppno":2768893700,"pcpadd":"495 E Main St","pcpcity":"Lebanon","pcpstate":"VA","pcpzip":"24266-4617","pcpcounty":"","pcpid":"P9058507","pcpname":"C HEALTH PC","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","aligned":"Y","ano":"","add2":"PO BOX 5824","add3":"","madd1":"","madd2":"PO BOX 5824","madd3":"","mcity":"KINGSPORT","mstate":"TN","mzip":"37663-0824","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z87.820","E53.8","Z23","R39.81","Z79.899","A41.9","J15.9","J96.01","E87.2","I95.9","J18.9","R65.21","D84.9","J90","G40.209","I31.3","Z20.828","M19.90","E03.9","E87.6","E83.42","K21.9","M06.9","Z86.69","R11.2","G40.409","R09.02","R53.1","R26.2","I10","Z20.822","R41.0","G40.909","D75.89","E55.9","M81.0","H54.7","F32.9","F41.9","R29.818","I65.23","I63.9","R56.9","I50.30","I51.7","E03.8","R27.0","G72.89","R26.81","R42","Z87.01","Z79.82","Z86.718","Z86.011","Z91.81","G40.109","N30.20","K44.9","R91.8","R19.7","J18.0","Z74.3","F43.22","M05.9","K56.609","W19.XXXA","L89.609","E27.9","T38.0X5A","Z66","Z09","R27.8","R53.81","J01.10","J06.9","R05","J01.90","D17.79","M79.89","J20.9","F33.9","G43.009","Z79.52","C71.9","R90.82","C72.30","R93.0"],"date":["2021-05-11","2021-01-25","2020-11-10","2021-06-26","2021-03-16","2020-12-23","2020-12-23","2020-12-23","2020-12-23","2020-12-23","2021-03-16","2020-12-21","2021-04-03","2020-12-18","2020-12-18","2021-04-07","2020-12-18","2021-01-05","2021-05-01","2021-04-07","2020-12-18","2021-05-01","2021-05-01","2020-12-21","2020-12-18","2020-12-18","2021-01-05","2021-04-17","2021-01-05","2021-05-21","2021-01-05","2021-01-05","2021-05-21","2021-03-16","2021-01-05","2021-04-03","2021-04-03","2021-05-01","2021-05-01","2021-01-06","2021-01-06","2021-01-06","2021-04-17","2021-01-07","2021-04-05","2021-01-20","2021-01-19","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-05-01","2021-02-04","2021-02-12","2021-05-21","2020-12-23","2020-12-22","2020-12-23","2021-01-05","2021-01-14","2021-03-16","2021-04-27","2021-04-03","2021-04-03","2021-04-03","2021-04-03","2021-04-03","2021-04-04","2021-04-07","2021-05-01","2021-04-23","2021-04-23","2021-04-23","2021-05-21","2021-04-03","2021-04-04","2021-04-27","2021-04-27","2021-04-29","2021-04-03","2021-06-10","2021-06-10","2021-06-10","2021-06-10"],"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":[["","378180510","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","70436000203","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","68180015701","CLOBAZAM","TAB 10MG","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","603533815","PREDNISONE","PAK 10MG","","Select","Select",""],["","65162073509","FELBAMATE","TAB 600MG","","Select","Select",""],["","62175061846","PANTOPRAZOLE","TAB 20MG","","Select","Select",""],["","47781057701","METHENAM HIP","TAB 1GM","","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","","Select","Select",""],["","228143503","LAMOTRIGINE","TAB 50MG ER","","Select","Select",""],["","378827052","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","378001401","METHOTREXATE","TAB 2.5MG","","Select","Select",""],["","65862069201","PHENYTOIN EX","CAP 100MG","","Select","Select",""],["","65162073509","FELBAMATE ","TAB 600MG","270","Select","Select",""],["","378180510","LEVOTHYROXIN ","TAB 75MCG","90","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","16","Select","Select",""],["","68180015701","CLOBAZAM ","TAB 10MG","60","Select","Select",""],["","603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","378827052","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","10","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","62175061846","PANTOPRAZOLE ","TAB 20MG","90","Select","Select",""],["","47781057701","METHENAM ","TAB 1GM","60","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","180","Select","Select",""],["","65162021211","PHENYTOIN ","CAP 100MG","270","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","228143503","LAMOTRIGINE ","TAB 50MG ER","540","Select","Select",""],["","93221001","SUCRALFATE ","1GM","120","Select","Select",""],["","378001401","METHOTREXATE ","2.5MG","72","Select","Select",""],["","68180065208","DOXYCYC ","100MG","11","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}