{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YHTORODKRALC L ","gend":1,"add":" HSUOB 108203 ETS TS","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1963-08-06","age":"","mstatus":"","insh":"04000910*513","cliId":"5WD1H61UE04","pno":"26\/7571616-5","cno":"757\/625-6161","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S06.5X0A","M25.511","M25.512","R26.2","M47.812","M54.12","S06.5X9A","M19.049","F51.01","G80.4","J45.40","F70.","E78.5","K21.9","I10.","R05.","Z23.","Z11.4","E55.9","G80.9","R30.0","J45.909","R10.12","S60.051A","M79.641","M79.642","M76.821","M76.822","M21.70","I73.9","M19.072","M19.071","M43.06","M53.2X6","M54.30","M21.371","M21.372","I62.00","S60.512A","Z88.5","Z88.8","Z91.030","Z91.09","Z88.0","Z88.2","B34.9","Z20.828","Z79.899","S09.90XA","Z00.00","Z20.822","R29.898","M24.872","B35.1","M79.674","M79.675","M76.62","M76.71","J30.89","H10.10","J45.30","Z12.31"],"date":["2020-10-29","2020-12-01","2020-12-01","2020-12-01","2021-06-24","2021-06-24","2020-12-14","2020-12-14","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-08-19","2021-01-21","2021-08-19","2021-06-04","2021-01-21","2021-01-21","2021-01-21","2021-03-04","2020-09-05","2020-09-05","2020-09-05","2020-10-07","2021-03-02","2021-03-02","2021-03-04","2021-03-04","2021-03-04","2021-08-25","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2020-10-29","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2021-01-22","2021-04-03","2020-12-18","2020-10-07","2021-01-21","2021-04-03","2021-03-02","2021-04-21","2021-08-25","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2021-06-04","2021-06-04","2021-06-04","2021-05-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","",null,"","",null,"","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","591292754","LEVALBUTEROL","AER 45\/ACT","15","Select","Select",""],["","378005301","CIMETIDINE","TAB 200MG","126","Select","Select",""],["","173060102","FLOVENT DISK","AER 250MCG","60","Select","Select",""],["","832532411","POT CL MICRO","TAB 10MEQ ER","90","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","904674740","IBUPROFEN","TAB 200MG","50","Select","Select",""],["","11822041923","8 HOUR PAIN","TAB 650MG","30","Select","Select",""],["","60505371309","LEVOCETIRIZI","TAB 5MG","28","Select","Select",""],["","16729000515","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","14","Select","Select",""],["","55111072510","MONTELUKAST","TAB 10MG","28","Select","Select",""],["","58160088552","FLUARIX QUAD","INJ 2020-21","0","Select","Select",""],["","31722073090","IRBESARTAN","TAB 150MG","90","Select","Select",""],["","63824000820","MUCINEX","TAB 600MG ER","30","Select","Select",""],["","65427325","PAZEO","DRO 0.007","5","Select","Select",""],["","61442010301","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","60219106501","POT CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","65862012701","TORSEMIDE","TAB 20MG","90","Select","Select",""],["","68382024705","BENZONATATE","CAP 100MG","30","Select","Select",""],["","4110080743",""," ","20","Select","Select",""],["","50111043303","TRAZODONE HYDROCHLORIDE","","14","Select","Select",""],["","832532411","POTASSIUM CHLORIDE ER","","90","Select","Select",""],["","11822041923","RA 8 HOUR PAIN RELIEF","","20","Select","Select",""],["","58160088552","FLUARIX QUADRIVALENT 2020-2021","","0","Select","Select",""],["","60505371309","LEVOCETIRIZINE DIHYDROCHLORIDE","","28","Select","Select",""],["","904674740","IBUPROFEN ","","50","Select","Select",""],["","173060102","FLOVENT DISKUS","","-60","Select","Select",""],["","55111072510","MONTELUKAST SODIUM ","","28","Select","Select",""],["","61442010301","DICLOFENAC SODIUM DR ","","30","Select","Select",""],["","591292754","LEVALBUTEROL TARTRATE HFA ","","15","Select","Select",""],["","50111091701","TORSEMIDE ","","90","Select","Select",""],["","63824000820","MUCINEX ","","30","Select","Select",""],["","55111072510","MONTELUKAST SODIUM","","28","Select","Select",""],["","61442010301","DICLOFENAC SODIUM DR","","30","Select","Select",""],["","00591292754","LEVALBUTEROL TARTRATE HFA","","15","Select","Select",""],["","49502010202","EPINEPHRINE","","2","Select","Select",""],["","58160088552","FLUARIX QUADRIVALENT 2020-2021                                        ","INJ 2020-21","0","Select","Select",""],["","55111072510","MONTELUKAST SODIUM                                                    ","TAB 10MG","28","Select","Select",""],["","61442010301","DICLOFENAC SODIUM DR                                                  ","TAB 75MG DR","30","Select","Select",""],["","11822041923","RA 8 HOUR PAIN RELIEF                                                 ","TAB 650MG","20","Select","Select",""],["","31722073090","IRBESARTAN                                                            ","TAB 150MG","90","Select","Select",""],["","00904674740","IBUPROFEN                                                             ","TAB 200MG","50","Select","Select",""],["","16729000515","SIMVASTATIN                                                           ","TAB 20MG","90","Select","Select",""],["","60505371309","LEVOCETIRIZINE DIHYDROCHLORIDE                                        ","TAB 5MG","28","Select","Select",""],["","68382080510","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","14","Select","Select",""],["","61442012110","FAMOTIDINE                                                            ","TAB 20MG","30","Select","Select",""],["","00173060102","FLOVENT DISKUS                                                        ","AER 250MCG","60","Select","Select",""],["","00378037201","CIMETIDINE                                                            ","TAB 400MG","63","Select","Select",""],["","00065427325","PAZEO                                                                 ","DRO 0.007","5","Select","Select",""],["","00832532411","POTASSIUM CHLORIDE ER                                                 ","TAB 10MEQ ER","90","Select","Select",""],["","50111091701","TORSEMIDE                                                             ","TAB 20MG","90","Select","Select",""],["","00591292754","LEVALBUTEROL TARTRATE HFA                                             ","AER 45\/ACT","15","Select","Select",""],["","04110080743","                                                                      "," ","20","Select","Select",""],["","68382024705","BENZONATATE                                                           ","CAP 100MG","30","Select","Select",""],["","49502010202","EPINEPHRINE                                                           ","INJ 0.3MG","2","Select","Select",""],["","63824000820","MUCINEX                                                               ","TAB 600MG ER","30","Select","Select",""],["","11822880980","RA MELATONIN                                                          ","TAB 3MG","90","Select","Select",""],["","57896076315","CALCIUM CARBONATE                                                     ","CHW 500MG","90","Select","Select",""],["","51645073515","CALCIUM ANTACID                                                       ","CHW 500MG","30","Select","Select",""],["","58160088752","FLUARIX QUADRIVALENT 2021-2022                                        ","INJ 2021-22","0","Select","Select",""],["","80681008500","MELATONIN                                                             ","TAB 3MG","90","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}