{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CATHY J PAULEY","gend":1,"add":"PO BOX 104  ","city":"ROSE HILL","state":"VA","zip":"24281-0104","dob":"1956-06-26","age":"","mstatus":"","insh":11018014,"cliId":"8HT3F00RE96","pno":2768320454,"cno":2768320454,"email":"","ename":"","eno":"","pphy":"MCQUEEN, KELLY ","ppno":4232243950,"pcpadd":"4600 Fort Henry Dr","pcpcity":"Kingsport","pcpstate":"TN","pcpzip":376632617,"pcpcounty":"","pcpid":"P0158947","pcpname":"WESTERN LEE COUNTY HEALTH CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 104  ","madd2":"","madd3":"","mcity":"ROSE HILL","mstate":"VA","mzip":"24281-0104","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.641","M79.642","G56.03","G20","M15.0","E11.42","I73.00","G89.4","F41.9","M72.0","E78.2","E03.9","H10.45","K59.00","K21.9"],"date":["2021-07-14","2021-07-14","2021-09-01","2021-09-01","2021-09-01","2021-10-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-10-01","2021-10-01","2021-09-01","2021-09-01","2021-09-01"],"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":[]},{"a":[]}]},{"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":[["","62756051813","CARB\/LEVO ","25-100MG","90","Select","Select",""],["","68462025801","ROPINIROLE ","4MG","60","Select","Select",""],["","16729045217","LEVOTHYROXIN ","112MCG","30","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30","Select","Select",""],["","16729004617","ATORVASTATIN ","40MG","30","Select","Select",""],["","69097012503","TOPIRAMATE ","200MG","60","Select","Select",""],["","00310654004","BYDUREON ","2\/0.85ML","3.4","Select","Select",""],["","50228017705","GABAPENTIN ","600MG","90","Select","Select",""],["","60505058604","OLOPATADINE ","0.002","2.5","Select","Select",""],["","43547040350","FUROSEMIDE ","80MG","30","Select","Select",""],["","24979001112","NIFEDIPINE ","30MG ER","30","Select","Select",""],["","00193731150","CONTOUR ","NEXT","100","Select","Select",""],["","61442012110","FAMOTIDINE ","20MG","60","Select","Select",""],["","00591040501","LISINOPRIL ","2.5MG","30","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","64380074207","BUSPIRONE ","10MG","60","Select","Select",""],["","43547040011","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","00088221905","LANTUS ","100\/ML","45","Select","Select",""],["","23155050110","HYDROXYZ","25MG","180","Select","Select",""],["","00310654004","BYDUREON","2\/0.85ML","3.4","Select","Select",""],["","16729045217","LEVOTHYROXIN","112MCG","30","Select","Select",""],["","69097012503","TOPIRAMATE","200MG","60","Select","Select",""],["","43547040350","FUROSEMIDE","80MG","30","Select","Select",""],["","61442012110","FAMOTIDINE","20MG","60","Select","Select",""],["","00591040501","LISINOPRIL","2.5MG","30","Select","Select",""],["","50228017705","GABAPENTIN","600MG","90","Select","Select",""],["","75834025701","ATORVASTATIN","40MG","30","Select","Select",""],["","68462025801","ROPINIROLE","4MG","60","Select","Select",""],["","24979001112","NIFEDIPINE","30MG ER","30","Select","Select",""],["","29300022010","MONTELUKAST","10MG","30","Select","Select",""],["","62756051813","CARB\/LEVO","25-100MG","90","Select","Select",""],["","60505058604","OLOPATADINE","0.002","2.5","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","64380074207","BUSPIRONE","10MG","60","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","90","Select","Select",""],["","00088221905","LANTUS","100\/ML","45","Select","Select",""],["","31722099705","HYDROCO\/APAP","10-325MG","120","Select","Select",""],["","00193731150","CONTOUR","NEXT","100","Select","Select",""],["","68462011944","FLUCONAZOLE","150MG","2","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","68382058201","LIOTHYRONINE","5MCG","30","Select","Select",""],["","23155050110","HYDROXYZ ","TAB 25MG","180","Select","Select",""],["","68382058201","LIOTHYRONINE ","TAB 5MCG","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","31722094205","HYDROCO\/APAP ","TAB 7.5-325","120","Select","Select",""],["","68462011944","FLUCONAZOLE ","TAB 150MG","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":""}]}]}