{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L ADNAWEDAEM ","gend":1,"add":"TS 9801RIALC ","city":"Oakwood","state":"VA","zip":"24631-9998","dob":"1963-08-12","age":"","mstatus":"","insh":"10113481","cliId":"","pno":"1367249222","cno":2764984215,"email":"","ename":"","eno":"","pphy":"PATEL, HARESH J","ppno":2769352148,"pcpadd":",","pcpcity":"Grundy","pcpstate":"VA","pcpzip":"24614-6975","pcpcounty":"","pcpid":"","pcpname":"TRI STATE CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1089 ST CLAIR","madd2":"","madd3":"","mcity":"Oakwood","mstate":"VA","mzip":"24631-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.116","L03.115","E11.42","I10","E66.01","J44.9","I50.9","M51.17","R39.81","G89.4","Z79.899","Z72.0","S81.802A","S81.801A","K21.9","M16.9","M19.90","I42.9","E66.09","R59.0","E87.6","F17.210","Z90.49","Z90.710","Z96.653","E78.5","I25.2","Z91.040","Z91.048","I73.9","Q82.0","E11.51","I87.2","L97.219","L97.229","L02.415","B96.89","I25.10","R10.9","R05.9","R11.0","I89.0","G43.109","J45.909","M13.852","E78.00","E88.81","L89.90","M54.40","M53.3","R25.2","I87.333","R11.2","R11.10","M06.9","Z88.8","Z79.02","Z79.1","L97.822","F17.200","G47.33","M19.91","E78.2","C95.90","R10.13","M51.16","K29.00","G89.29","M79.605","M79.604","R60.0","L97.929","L97.919","Z91.19","Z79.891","J30.1","I70.209","Z13.6","S81.802D","S81.801D","E87.2","Z68.43","L02.416","L40.9","Z20.828","R19.7","E86.0","I11.0","R09.02","Z20.822","M17.0","F17.218","E66.9","Z68.42","R06.02","R05","M79.89","L97.812","Z71.6","R00.2","J20.9","E16.2","R56.9","G25.3","E11.621","K29.70","I51.7","R53.83","R53.81","M17.9","R32","E11.9","R60.9","H10.9","J98.4","I27.20","G56.22","R06.00","Z86.79","M54.5","S30.0XXD","L97.519","L97.529","I87.393","F17.219","I50.812","R30.0","L97.309","R94.31","B35.4","K52.9","S32.000B","M81.0","M54.9","M54.50","M54.2","M85.80","S32.040D","Z13.820","Z78.0","M79.602","R53.1","L30.9","R21","Z02.89","Z79.01","M54.12","M25.511","M25.512","M75.102","M75.101","M75.01","M19.011","M19.012"],"date":["2021-04-01","2021-04-01","2023-07-19","2023-07-19","2023-07-19","2022-05-16","2023-06-16","2023-02-07","2023-05-08","2021-06-09","2023-04-18","2021-06-09","2023-03-28","2023-03-28","2022-05-05","2023-07-19","2023-05-22","2020-02-25","2020-10-05","2021-02-13","2021-03-31","2023-04-28","2021-02-13","2021-02-13","2021-02-13","2023-04-06","2022-06-07","2022-06-07","2021-02-13","2021-04-01","2023-03-28","2021-04-01","2022-02-17","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2022-06-07","2023-07-25","2022-06-07","2022-05-20","2021-09-24","2023-07-19","2023-05-22","2022-12-09","2022-10-14","2022-09-16","2021-04-05","2021-03-31","2021-03-31","2023-04-06","2023-03-28","2022-12-28","2023-07-25","2022-06-07","2022-06-07","2022-06-07","2021-03-02","2020-10-14","2020-10-14","2021-08-01","2021-02-01","2022-04-14","2021-02-01","2022-12-28","2022-07-20","2021-07-30","2021-03-02","2021-03-02","2023-03-08","2023-04-06","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2023-06-21","2022-04-14","2022-10-25","2021-08-01","2021-08-01","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2022-12-28","2020-12-19","2023-04-28","2022-06-09","2022-06-07","2020-05-11","2022-04-15","2022-04-14","2022-04-14","2021-03-15","2021-03-15","2020-12-19","2020-10-14","2021-01-19","2021-03-17","2021-11-22","2022-12-16","2020-05-14","2020-05-14","2020-12-20","2022-06-06","2022-06-07","2023-04-06","2023-04-06","2020-04-13","2020-06-08","2023-06-22","2020-10-26","2020-06-25","2022-06-09","2022-06-09","2021-03-31","2022-06-07","2022-06-07","2021-03-31","2022-05-16","2022-04-15","2022-04-15","2022-04-15","2022-10-25","2020-07-06","2022-05-20","2022-02-17","2020-10-14","2022-07-07","2023-05-31","2023-03-15","2023-03-15","2023-03-08","2023-07-19","2023-05-31","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-08","2023-03-08","2023-04-28","2023-04-28","2023-04-18","2023-04-18","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31"],"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":[]},{"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":[["","57237023305","SMZ-TMP DS","TAB 800-160","20","Select","Select",""],["","68001016208","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","65162011511","HYDROCO\/APAP","TAB 7.5-325","60","Select","Select",""],["","68001033508","LISINOPRIL","TAB 20MG","60","Select","Select",""],["","00168009960","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","31722055190","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","68180046403","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","29300016910","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","68001011900","METOPROL SUC","TAB 100MG ER","60","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","59385002260","BELBUCA","MIS 150MCG","60","Select","Select",""],["","68001023500","POT CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","68382080001","LABETALOL","TAB 300MG","60","Select","Select",""],["","68001023803","CLONIDINE","TAB 0.2MG","90","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","60505003306","PENTOXIFYLLI","TAB 400MG ER","60","Select","Select",""],["","68180024108","LEVOFLOXACIN","TAB 500MG","14","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","42571016242","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","47781022905","OXYCOD\/APAP","TAB 7.5-325","10","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","60","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","00093681673","BUDESONIDE","SUS 0.5MG\/2","120","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00168008130","NYSTAT\/TRIAM","CRE ","30","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","30","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","45963053830","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","50111033301","METRONIDAZOL","TAB 250MG","45","Select","Select",""],["","68382070718","DOXYCYC MONO","CAP 100MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","40","Select","Select",""],["","00378034501","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8.5","Select","Select",""],["","57237017090","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","00378459710","METOPROLOL","TAB 100MG ER","60","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","20","Select","Select",""],["","68001011900","METOPROL","TAB 100MG ER","60","Select","Select",""],["","68001023500","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00173072020","FLOVENT","AER 220MCG","12","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68382070718","DOXYCYC","CAP 100MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","57237023305","SMZ-TMP DS TAB","800-160","20","Select","Select",""],["","68001016208","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","65162011511","HYDROCO\/APAP TAB","7.5-325","60","Select","Select",""],["","59385002260","BELBUCA MIS","150MCG","60","Select","Select",""],["","29300016910","TIZANIDINE TAB","4MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","68180046403","SIMVASTATIN TAB","40MG","30","Select","Select",""],["","31722055190","LEVOCETIRIZI TAB","5MG","30","Select","Select",""],["","68001033508","LISINOPRIL TAB","20MG","60","Select","Select",""],["","00168009960","KETOCONAZOLE CRE","2%","60","Select","Select",""],["","62175013643","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","68001023500","POT CL MICRO TAB","20MEQ ER","60","Select","Select",""],["","68382080001","LABETALOL TAB","300MG","60","Select","Select",""],["","67877032105","IBUPROFEN TAB","800MG","60","Select","Select",""],["","68001023803","CLONIDINE TAB","0.2MG","90","Select","Select",""],["","60505083001","MOMETASONE SPR","50MCG","17","Select","Select",""],["","60505003306","PENTOXIFYLLI TAB","400MG ER","60","Select","Select",""],["","00378210001","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","47781022905","OXYCOD\/APAP TAB","7.5-325","10","Select","Select",""],["","68001011900","METOPROL SUC TAB","100MG ER","60","Select","Select",""],["","24208083060","NEO\/POLY\/DEX SUS","0.1% OP","5","Select","Select",""],["","00168008130","NYSTAT\/TRIAM CRE","","30","Select","Select",""],["","57237001760","DULOXETINE CAP","20MG","30","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","45963053830","ONDANSETRON TAB","4MG","30","Select","Select",""],["","50111033301","METRONIDAZOL TAB","250MG","45","Select","Select",""],["","68382070718","DOXYCYC MONO CAP","100MG","30","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","63304069201","CLINDAMYCIN CAP","150MG","40","Select","Select",""],["","00378034501","DIAZEPAM TAB","5MG","1","Select","Select",""],["","00173072020","FLOVENT HFA AER","220MCG","12","Select","Select",""],["","59310057922","PROAIR HFA AER","","8.5","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","57237017090","ROSUVASTATIN TAB","20MG","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8.5","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}