{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELLICULSILLIW C","gend":1,"add":"            NOSNHOJ ADNIL                         ","city":"MIDLOTHIAN               ","state":"VA","zip":"23112-6825","dob":"1931-04-25","age":"","mstatus":"","insh":"00112361","cliId":"","pno":"4740829183","cno":"","email":"","ename":"","eno":"","pphy":"JIMA, BOGALE","ppno":8047390910,"pcpadd":"13861 HULL STREET,STE 1B","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":231122091,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"12624 BUFFALO NICKEL DRIVE                        ","add3":"","madd1":"LINDA JOHNSON                                     ","madd2":"12624 BUFFALO NICKEL DRIVE                        ","madd3":"","mcity":"MIDLOTHIAN               ","mstate":"VA","mzip":"23112-6825","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40.1133","Z96.1","H35.81","E11.3393","H34.8112","R11.0","E78.00","E11.65","R07.9","N60.01","R92.8","N64.89","I12.9","N18.3","E78.5","K21.9","M25.50","F41.9","Z71.89","R05","E11.319","E78.2","E11.51","E11.22","E11.59","F34.1","R93.89","I25.10","E11.9","I10","H26.491","H52.4","R82.90","H34.8320","H35.352","R15.9","K59.00","M15.0","Z79.1","Z79.84","Z79.899","Z99.3","R07.89","Z12.31","N30.00","N39.0","E11.21","D64.9","Z68.27","J01.00","H93.13","H91.12","D04.72","D48.5","L91.9","F33.0","G47.9","H40.9","H61.23","M15.9","M47.812","Z68.26","Z86.79","M20.42","M20.41","I73.9","N18.30","N63.10","E55.9","C44.729","D63.8","Z23","B35.1","E11.49","N63.11","F33.9","E11.3299","J30.9","R52","Z80.9","M17.0","Z91.81","E04.9","R07.2","Z01.818","R63.4","H93.12","H69.82","H61.22","R70.0","H91.93","Z82.49","Z83.3","Z85.3","Z88.2","F32.9","M47.816","Z68.25","R91.8","J06.9","N18.9","R09.81","R53.82","G44.89","R51","Z79.51","D24.1","H53.9","H93.19","R09.82","Z97.2","I20.9","K44.9","K59.09","Z13.6","E11.36","F41.1","E11.39","Z88.8","Z74.1","Z87.39","E05.90","M19.90","R80.9","Z00.00"," ","F41.8","N81.10"],"date":["2021-12-22","2021-12-22","2018-01-11","2018-01-11","2018-01-11","2021-04-27","2021-09-22","2022-09-22","2020-07-08","2019-07-17","2019-07-11","2019-07-11","2022-09-30","2020-06-11","2022-09-30","2022-09-30","2018-09-27","2021-09-22","2021-11-09","2019-11-19","2021-11-09","2021-11-09","2021-11-09","2022-09-30","2021-11-09","2021-11-09","2019-11-19","2019-11-19","2022-09-22","2022-11-01","2021-12-22","2021-12-22","2022-09-30","2020-06-18","2020-06-18","2022-10-29","2022-10-29","2022-10-29","2018-03-13","2022-03-22","2021-11-09","2020-11-02","2020-07-08","2021-10-21","2021-11-01","2021-11-01","2021-11-01","2022-09-22","2020-06-25","2019-02-05","2019-02-05","2019-02-05","2021-03-05","2021-03-05","2021-03-05","2018-03-13","2018-03-13","2019-09-05","2019-02-26","2018-03-13","2018-03-13","2018-03-13","2019-03-28","2019-04-30","2019-04-30","2022-08-25","2022-09-30","2019-07-17","2022-09-22","2021-04-08","2018-05-10","2018-05-10","2022-08-25","2018-05-17","2019-07-11","2019-09-05","2019-09-05","2019-09-05","2022-08-25","2019-09-05","2020-11-02","2020-09-10","2020-09-10","2020-06-14","2021-03-25","2022-03-22","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-09-05","2019-09-05","2020-11-02","2019-09-05","2021-11-09","2020-11-02","2020-11-02","2019-11-19","2019-02-26","2021-05-06","2019-06-06","2019-07-02","2019-07-02","2019-06-06","2020-06-14","2019-07-17","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2022-06-30","2022-10-29","2022-09-30","2022-03-22","2022-11-01","2022-09-30","2022-09-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00023921105","COMBIGAN","SOL 0.2\/0.5%","15","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","31722057230","ESOMEPRA","CAP 20MG DR","90","Select","Select",""],["","60505014101","GLIPIZIDE","TAB 5MG","180","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","50742061710","METOPROL","TAB 100MG ER","135","Select","Select",""],["","33342006410","VALSARTAN","TAB 160MG","90.00","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","90","Select","Select",""],["","68382097001","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","20","Select","Select",""],["","70461012103","FLUAD","INJ 2021-22","0.5","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","49884064001","METHIMAZOLE","TAB 5MG","60.00","Select","Select",""],["","59762372004","ALPRAZOLAM","TAB 0.5MG","120","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","49281040565","FLUZONE","INJ PF 19-20","0.5","Select","Select",""],["","60505622500","BRIMO\/TIMOLO","SOL 0.2\/0.5%","15","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0.3","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","55111012601","CIPROFLOXACN","TAB 250MG","6","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","55111032201","GLIMEPIRIDE","TAB 4MG","90","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":""}]}]}