{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L EINREVSREGOR ","gend":1,"add":"     .RD LLAH RALPOP 0295                         ","city":"NORFOLK                  ","state":"VA","zip":"23502-9998","dob":"1935-08-09","age":"","mstatus":"","insh":"00113602","cliId":"","pno":"2675721252","cno":"","email":"","ename":"","eno":"","pphy":"GRANT, THOMAS R","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE 1ST FLOOR SUITE 118,HOFHEIMER HALL","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"","pcpname":"GHENT FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"5920 POPLAR HALL DR.                              ","madd2":"                                                  ","madd3":"","mcity":"NORFOLK                  ","mstate":"VA","mzip":"23502-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E11.65","I10","E78.5","N18.30","I50.30","G47.33","G47.10","R06.02","M25.512","M05.79","G96.9","Z00.00","M79.2","Z23","E55.9","E11.42","N18.3","S86.819A","M79.661","I50.9","M79.676","E10.40","L03.039","L60.0","R06.09","Z68.38","N39.0","R19.7","E78.00","Z87.891","R15.9","R39.81","N39.46","Z12.31","E10.9","E11.49","I11.0","J45.909","I25.10","Z79.4","J44.9","J98.4","M62.81","R26.81","M79.606","I08.3","N60.82","E11.649","E16.2","E11.40","Z99.89","R07.89","I50.32","E04.2","R07.9","Z86.79","R60.0","R91.8","E66.9","R09.02","Z99.81","R61","N64.89","R92.8","D63.8","L85.3","L29.9","M17.11","Z68.37","E04.9","R06.00","Z20.828","R29.6","R19.5","H40.013","H04.123","Z86.39","R60.9","H90.3","R94.2","E13.42","R26.89","M15.9","M17.0","E11.22","M19.90","N18.9","Z09","M75.02","M17.10","I12.9","I11.9","E66.2","K08.109","M79.662","R32","Z79.82","Z97.2","Z97.3","Z79.84","H53.9","G47.30","M19.012","H91.90","Z89.029","J98.01","Z68.36","G89.29","T87.89","E66.01","E11.51","D50.9","E07.89","M79.605","M79.1","M25.569","M48.02","M54.5","E11.621","L97.509","R10.9","N63.21","N63.20","G57.00","H90.5","L30.8","Z13.31","Z79.899","Z88.6","R06.83","K59.00","R53.1","H91.8X1","J06.9","R05","R53.81","R09.81","B97.89","Z86.010","R10.10","E87.5","R10.84","E88.81","F03.90","G47.00","J30.9","Z77.22","Z82.49","Z83.3","Z87.440","Z89.021","R73.9","E11.3393","M75.42","M79.675","L03.032","M79.674","L03.031","M54.2","M54.51","M25.511","R39.9","R63.4","M25.561","S39.92XA","M54.50","S39.93XA","R10.2","M25.461","M53.3","V89.2XXA","Y92.410","R30.0","S19.9XXA","M75.40"," ","R41.0","I67.82","I13.0","N18.31","N17.9","G92.8","H02.413","U07.1","M62.830","H02.423","Z20.822","R41.82","M19.011"],"date":["2022-12-02","2022-11-22","2022-12-06","2022-11-22","2022-07-21","2022-11-14","2022-11-14","2022-11-14","2021-06-23","2022-10-13","2021-10-05","2020-08-24","2022-05-13","2021-12-12","2021-03-27","2022-01-21","2021-10-05","2020-05-11","2018-04-26","2018-09-27","2022-11-01","2021-12-07","2022-10-25","2021-12-07","2022-10-25","2019-06-11","2020-10-31","2022-05-18","2022-11-14","2022-11-14","2022-03-21","2022-11-14","2022-11-14","2022-11-14","2021-10-19","2020-12-14","2022-05-13","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-12-12","2021-12-12","2021-12-12","2021-12-12","2020-10-27","2021-11-03","2019-11-24","2019-11-24","2022-06-14","2020-10-19","2022-05-31","2022-12-06","2022-08-26","2021-05-25","2020-11-09","2021-06-23","2022-06-28","2022-06-28","2020-11-16","2021-03-31","2019-10-26","2021-10-28","2021-10-28","2020-12-16","2021-02-22","2021-02-22","2022-06-17","2021-05-13","2021-05-13","2022-12-06","2020-11-09","2022-01-25","2018-08-06","2019-08-22","2019-08-22","2018-01-10","2020-10-31","2018-02-21","2019-05-07","2021-03-31","2021-03-31","2022-03-08","2022-11-22","2022-11-14","2022-07-21","2022-06-28","2019-06-11","2020-06-15","2021-11-23","2022-06-28","2020-09-14","2018-09-27","2020-10-31","2018-09-27","2020-10-31","2022-11-14","2020-10-31","2018-09-27","2022-11-14","2020-10-31","2020-10-31","2022-03-21","2020-10-31","2020-10-31","2020-11-16","2020-11-16","2022-07-21","2019-08-07","2022-11-14","2019-08-07","2022-11-14","2021-09-29","2018-03-01","2018-03-01","2022-07-21","2022-11-14","2020-06-11","2019-04-29","2019-04-29","2019-07-31","2021-11-02","2021-10-28","2018-02-07","2019-05-03","2021-05-24","2022-05-13","2022-11-14","2022-06-28","2019-03-17","2021-04-29","2021-02-11","2018-02-21","2019-03-16","2019-03-16","2019-03-16","2019-03-16","2019-03-16","2019-05-27","2019-05-27","2019-05-27","2019-07-31","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2020-09-14","2022-11-30","2022-03-08","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-13","2022-10-13","2022-10-13","2022-07-21","2022-07-21","2022-06-14","2022-06-28","2022-07-01","2022-06-28","2022-06-28","2022-06-14","2022-06-28","2022-06-28","2022-06-28","2022-07-21","2022-06-28","2022-05-18","2022-12-06","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-30","2022-08-31","2022-09-13","2022-12-05","2022-08-18","2022-11-14","2022-11-11"],"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":[["","72205001390","PREGABALIN","CAP 75MG","60","Select","Select",""],["","00006057761","JANUMET","TAB 50-1000","30","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","16714066202","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","16714085201","METOPROL","TAB 25MG ER","45","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","60505017007","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","73070010011","INSULIN","INJ 100\/ML","20","Select","Select",""],["","08560940003","V-GO","KIT ","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","TES PREC NEO","50","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","40","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00169750111","NOVOLOG","INJ 100\/ML","20","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","21","Select","Select",""],["","51672130104","AMMONIUM","CRE 0.12","280","Select","Select",""],["","591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","16571041210","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","100","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","00071101468","LYRICA","CAP 75MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00193654621","BAYER","MIS LANCETS","100","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","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":""}]}]}