{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EIXIDNOEL V","gend":1,"add":"        DAOR ARODNYL 6502                         ","city":"VIRGINIA BEACH           ","state":"VA","zip":"23464-8618","dob":"1973-04-09","age":"","mstatus":"","insh":"00119279","cliId":"","pno":"7975761379","cno":"","email":"","ename":"","eno":"","pphy":"NEGRON, KIRSTIN H","ppno":7573051797,"pcpadd":"828 HEALTHY WAY STE 220,STE 301","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234627960,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APT 103                                           ","add3":"","madd1":"816 Broad Meadows Ct Apt 103                      ","madd2":"                                                  ","madd3":"","mcity":"Virginia Beach           ","mstate":"VA","mzip":"23462-1379","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75.02","M25.512","E10.618","E10.65","E10.21","E10.43","I10","F31.9","E66.01","E03.9","Z78.9","K31.84","Z68.34","F31.62","F31.30","E13.8","F31.0","E08.40","E03.8","E06.3","E10.8","Z79.4","K08.409","Z79.82","K21.9","F32.9","E11.40","E11.9","Z96.41","Z85.42","E11.65","E11.42","M25.511","M79.18","R07.2","E11.43","Z82.49","R07.9","H25.13","G62.9","L98.9","M25.50","M79.10","M89.9","R68.89","Z11.59","E55.9","M85.89","R74.8","E53.8","M54.5","M25.551","G89.29","M25.552","M16.0","M51.36","F33.1","M17.0","M19.072","M19.071","E78.2","F40.240","Z91.19","C54.1","G89.4","Q76.49","E89.40","H57.89","Z13.820","N95.9","M85.80","Z78.0","M62.830","M70.72","M53.3","T50.905A","E66.9","Z12.31","M70.62","R10.2","Z68.30","Z23","Z68.33","N30.00","R82.90","E78.5","E11.21","Z00.00","G47.33","G47.00","R06.00","J45.20","Z99.89","Z20.828","M19.012","M67.814","H40.013","M79.602","Z51.81","Z01.810","R94.31"," ","J44.9","G89.18","M65.9","L71.9","L21.9","Z68.37","K59.00","M65.112","E11.69","L70.9","Z01.812","Z91.14","L71.8","L21.8","Z68.35"],"date":["2022-06-07","2022-08-02","2021-03-23","2022-07-20","2021-12-01","2021-06-14","2022-07-20","2021-06-14","2022-07-20","2022-07-20","2022-03-02","2021-01-11","2021-12-01","2022-09-12","2022-11-23","2020-01-16","2022-11-07","2020-11-25","2022-11-14","2022-11-14","2020-06-30","2022-11-14","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2022-06-07","2020-08-19","2020-08-07","2022-11-14","2022-11-14","2020-02-21","2020-02-21","2020-02-21","2020-10-13","2020-02-21","2020-02-21","2021-12-02","2022-07-20","2021-03-23","2020-06-30","2020-05-07","2020-06-01","2020-05-01","2021-05-03","2021-09-22","2021-05-03","2021-05-03","2020-05-07","2020-08-07","2020-08-05","2022-03-02","2020-09-30","2020-08-07","2020-05-18","2020-05-27","2020-06-01","2020-06-01","2020-06-01","2022-07-20","2021-06-14","2021-06-14","2021-12-10","2020-06-30","2020-08-07","2020-08-07","2020-06-30","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-08-03","2020-08-03","2020-08-07","2020-08-07","2022-11-14","2022-10-27","2020-09-30","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-29","2021-09-29","2022-11-14","2020-10-13","2022-07-20","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-14","2021-10-27","2021-10-27","2021-12-02","2022-02-23","2021-12-01","2022-05-10","2022-05-10","2022-11-23","2022-06-07","2022-06-07","2022-06-07","2022-09-14","2022-09-14","2022-07-20","2022-07-20","2022-06-07","2022-11-14","2022-03-23","2022-05-10","2022-05-10","2022-11-16","2022-11-16","2022-03-02"],"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":[["","00591367101","NABUMETONE","TAB 750MG","60","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","5","Select","Select",""],["","69238184001","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","45802073684","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","65862020299","LOSARTAN","TAB 50MG","90","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","21","Select","Select",""],["","8290320550","BD  PEN NEEDL","MIS 32GX4MM","200","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","08627001601","DEXCOM","MIS TRANSMIT","1","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","169406012","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","23155013301","DOXYCYC","TAB 50MG","30","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","43547034350","RISPERIDONE","TAB 3MG","30","Select","Select",""],["","713075737","METRONIDAZOL","CRE 0.0075","45","Select","Select",""],["","168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","21","Select","Select",""],["","61874011520","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","93321930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","7","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","120","Select","Select",""],["","406055201","OXYCODONE","TAB 5MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00169750111","NOVOLOG","INJ 100\/ML","90","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","51862094205","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","406051205","OXYCOD\/APAP","TAB 5-325MG","35","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","180","Select","Select",""],["","63402019103","LUNESTA","TAB 2MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","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":""}]}]}