{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IROJRAMELKET E","gend":1,"add":"      TRUOC LEUNAM   9326                         ","city":"N CHESTERFIELD           ","state":"VA","zip":"23234-5895","dob":"1955-09-18","age":"","mstatus":"","insh":"00119624","cliId":"","pno":"6640830168","cno":"","email":"","ename":"","eno":"","pphy":"MARSHALL, CHRISTOPHER GEORGE","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":"                                                  ","add3":"","madd1":"6239   MANUEL COURT                               ","madd2":"                                                  ","madd3":"","mcity":"N CHESTERFIELD           ","mstate":"VA","mzip":"23234-5895","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.50","J96.10","Z71.9","I10","E78.00","E09.9","J84.10","K21.9","E53.8","M17.0","G47.33","J96.11","F32.1","Z99.81","R53.81","E11.42","H40.1113","J45.40","E66.9","R25.2","E78.5","E11.9","R63.5","J44.9","J82","J84.9","A41.9","R65.10","J96.21","J44.1","J41.0","H91.93","M51.26","S09.90XA","V89.9XXA","S49.92XA","S79.912A","J18.9","R05","R53.83","Z20.822","J44.0","Z68.29","Z79.84","Z79.82","Z79.51","R91.8","R06.2","R06.02","Z68.41","B37.0","L20.84","Z12.31","D64.9","B02.9","R21","I11.0","I50.9","Z68.21","F33.1","I51.7","R30.0","R01.1","Z13.29","H40.1133","J31.0","Z92.29","Z13.820","R06.83","H40.1112","H40.1123","H04.123","H25.13","Z23","J45.901","E87.79","E87.70","Z87.891","E11.36","E66.01","E78.2","F32.0","G47.01","H40.9","J34.89","K08.109","Z86.11","Z68.39","R91.1","B35.1","E11.49","M79.671","M79.672","Z20.828","T46.4X5A","R41.3","B35.4","M54.5","M25.512","R51","V87.7XXA","Y92.410","M25.552","Z68.42","F32.9","F41.1","H40.1413","H90.5","M85.88","H90.3","R06.82","R42","R60.0","Z79.1","Z79.2","Z87.01","Z97.3","L30.1","J45.909","Z12.39","H40.1132","R20.2","R06.00","I15.9","I51.9","M79.2","Z91.81","L25.9","M17.11","M25.561","M25.461","R00.2","E87.6","I49.1","R51.9","R94.31","R11.0"," "],"date":["2022-12-05","2022-12-05","2022-03-08","2022-10-18","2021-10-27","2020-10-09","2022-11-21","2021-04-28","2021-10-27","2020-03-18","2022-11-27","2022-11-21","2021-04-28","2020-03-18","2022-03-08","2022-07-07","2019-07-16","2020-03-30","2022-10-07","2020-10-09","2022-10-18","2022-10-18","2020-10-09","2022-10-18","2019-11-29","2020-03-30","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2019-08-23","2020-07-23","2018-08-01","2018-08-01","2018-08-01","2018-08-01","2018-08-01","2021-12-07","2021-08-28","2021-08-28","2021-12-03","2021-12-03","2021-08-28","2022-09-08","2022-10-18","2022-10-18","2022-10-18","2018-09-12","2022-10-18","2018-09-12","2018-10-26","2018-10-26","2021-07-01","2022-08-16","2021-12-19","2022-08-16","2021-12-19","2021-12-19","2021-12-19","2019-08-23","2018-09-12","2021-09-24","2021-12-06","2022-02-24","2019-06-18","2019-06-11","2019-06-11","2021-07-01","2021-08-26","2019-02-04","2019-06-05","2019-02-04","2019-02-04","2022-10-07","2021-12-07","2021-12-06","2021-12-06","2022-09-08","2018-10-02","2018-10-02","2018-10-02","2018-10-02","2018-10-02","2018-10-02","2018-10-02","2018-10-02","2021-12-03","2021-12-03","2022-09-08","2018-12-06","2018-12-06","2018-12-06","2018-12-06","2021-02-05","2021-07-28","2021-07-28","2021-07-28","2018-08-01","2018-08-01","2018-08-01","2018-08-01","2018-08-01","2018-08-01","2018-10-02","2021-04-16","2021-04-16","2019-07-16","2021-04-20","2021-07-01","2020-07-23","2018-10-02","2022-10-18","2020-11-05","2018-10-02","2018-10-02","2018-10-02","2018-10-02","2020-11-05","2021-12-03","2021-04-28","2021-08-27","2022-02-24","2022-02-24","2022-04-16","2022-11-22","2022-07-07","2022-07-07","2022-07-10","2022-06-10","2022-06-10","2022-06-10","2022-09-08","2022-09-08","2022-09-08","2022-11-09","2022-10-18","2022-10-18","2022-12-05"],"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":[["","00378021610","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","66993066330","DULOXETINE","CAP 30MG","60","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","00310009530","DALIRESP","TAB 500MCG","30","Select","Select",""],["","00173088101","NUCALA","INJ 100MG","1","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","14","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","64980028101","GLIPIZIDE","TAB 10MG","90","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","10","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","30.6","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","45","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","70461012003","FLUAD","INJ 0.5ML","0.5","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","2","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","24208048510","DORZOLAMIDE","SOL 2% OP","10","Select","Select",""],["","00065924007","DUREZOL","EMU 0.0005","5","Select","Select",""],["","50383026830","CLOBETASOL","OIN 0.0005","30","Select","Select",""],["","68382075905","METFORMIN","TAB 850MG","180","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0.5","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","61314014415","BRIMONIDINE","SOL 0.0015","15","Select","Select",""],["","00093681773","BUDESONIDE","SUS 1MG\/2ML","480","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":""}]}]}