{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARY   L MOORE","gend":0,"add":"240 MOORE STREET APT 515","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"1955-06-30","age":"","mstatus":"","insh":"900040452*01","cliId":"","pno":"276\/494-2465","cno":"","email":"","ename":"","eno":"","pphy":"ORTIZ, VICENTE MD","ppno":"276\/944-3999","pcpadd":"13168 MEADOWVIEW SQUARE","pcpcity":"MEADOWVIEW","pcpstate":"VA","pcpzip":24361,"pcpcounty":"","pcpid":"","pcpname":"SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/944-3882","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.645","S62.515D","J44.9","M25.532","L03.114","F17.210","M89.8X6","M54.9","Z96.651","Z96.652","Z47.1","Z96.653","M77.8","Z23.","F33.3","F10.20","M17.0","Z00.01","E78.5","I10.","K21.9","F12.259","S62.512A","F33.1","R06.02","W01.0XXA","Z12.11"],"date":["2020-10-26","2020-10-05","2021-12-10","2021-10-07","2021-10-07","2021-10-07","2020-12-09","2021-08-27","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-12-10","2021-03-24","2021-07-06","2021-07-06","2021-02-24","2021-04-28","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2020-10-26","2021-01-07","2021-02-24","2021-10-07","2021-08-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862062405","GEMFIBROZIL                                                           ","600MG","30","Select","Select",""],["","68382080601","TRAZODONE HYDROCHLORIDE                                               ","100MG","30","Select","Select",""],["","00085461001","DULERA                                                                ","200-5MCG","13","Select","Select",""],["","66993058597","FLUTICASONE PROPIONATE\/SALMETEROL DISKUS                              ","250\/50","60","Select","Select",""],["","00173088210","BREO ELLIPTA                                                          ","200-25","60","Select","Select",""],["","62175061746","PANTOPRAZOLE SODIUM                                                   ","40MG","60","Select","Select",""],["","16714045701","QUETIAPINE FUMARATE                                                   ","400MG","60","Select","Select",""],["","62135021001","FOLIC ACID                                                            ","1MG","30","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE                                                   ","5MG","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA                                                 ","HFA","8","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE                                              ","4MG","42","Select","Select",""],["","69238110002","DOXYCYCLINE HYCLATE                                                   ","100MG","14","Select","Select",""],["","00406012301","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","5-325MG","12","Select","Select",""],["","00121477600","MEGESTROL ACETATE                                                     ","400MG\/10","600","Select","Select",""],["","42806040021","METHYLPREDNISOLONE DOSE PACK                                          ","4MG","-21","Select","Select",""],["","00093094801","DICLOFENAC POTASSIUM                                                  ","50MG","90","Select","Select",""],["","57237001760","DULOXETINE HYDROCHLORIDE                                              ","20MG","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}