{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ETTENOITNANOSNHOJ R  ","gend":1,"add":"HSINAPS 851B TPA LRT ","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1964-01-23","age":"","mstatus":"","insh":"73000910*073","cliId":"2Y22GG3HJ88","pno":"62\/7572139-8","cno":"757\/268-9312","email":"","ename":"","eno":"","pphy":"LORENZO, DAVID A MD","ppno":"757\/499-7442","pcpadd":"SUITE 250 4505 COLUMBUS STREET","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":102433,"pcpname":"CMG - Town Center Pediatrics","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":["E11.9","M20.42","M20.41","I87.2","L84.","B35.1","M79.671","M79.672","M75.42","M75.52","E11.65","E11.649","T38.3X6A","Z76.0","Z91.138","I11.0","I50.9","D57.3","Z87.891","Z88.0","Z79.4","Z79.899","Z91.013","R42.","Z48.816","I50.30","D64.9","M54.5","F32.9","F41.9","E78.00","R32.","E66.01","Z68.41","Z79.82","Z91.81","Z02.9","I10.","E78.5","K59.00","Z82.49","H25.12","R06.09","I42.9","E64.9","M50.320","M25.612","R07.9","Z28.21","N89.8","B37.9","Z12.31","Z12.11","H25.11","G43.109","H35.033","H26.493","H04.123","H01.02A","H01.02B","H04.121","H04.122","E11.3293","F43.20","E11.8","E11.69","E11.59","H25.13","H18.51","Z00.00","M25.512","K59.09","Z53.29","L43.8","L29.8","L53.8","M79.659","R55.","M16.0","M25.561","M25.562","M70.71","M70.72","M22.41","M19.90","Z23.","I15.2","M22.42","M17.0","M51.36","L60.3","E11.42","R10.2","R18.8","Z90.710","Z90.722","N94.89","Z91.040","R10.9","M53.3"],"date":["2021-09-06","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-10-26","2020-12-04","2020-12-04","2021-01-13","2021-01-13","2021-08-02","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-09-05","2021-09-05","2021-02-05","2021-09-06","2021-09-05","2021-11-10","2021-11-10","2021-09-05","2021-02-05","2020-02-10","2020-02-10","2020-08-10","2021-09-06","2020-02-10","2020-03-25","2020-02-10","2020-02-10","2021-08-02","2021-08-02","2021-11-10","2020-02-10","2021-02-23","2021-09-06","2021-08-02","2020-01-27","2020-01-27","2020-08-19","2020-02-24","2020-02-24","2020-08-11","2020-11-25","2020-11-25","2021-02-05","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-05-23","2020-08-12","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2021-02-15","2021-08-02","2021-08-02","2021-08-02","2020-07-17","2020-07-17","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-03-02","2020-03-02","2020-03-02","2020-03-25","2021-02-05","2021-05-03","2021-06-02","2021-06-02","2021-06-30","2021-06-30","2021-07-28","2021-07-07","2021-07-07","2021-08-02","2021-07-28","2021-08-20","2021-07-28","2021-08-09","2021-10-26","2021-10-05","2021-11-10","2021-11-10","2021-11-10","2021-09-05","2021-09-05","2021-09-05","2021-09-05"],"priorHcc":[null,"","","","",null,"","","","","","","","","",null,null,"",null,null,null,null,null,"","","","",null,"","","","","","",null,"","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null,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":[["","68180072103","AMLODIPINE","TAB 10MG","-30","Select","Select",""],["","169368712","LEVEMIR","INJ ","30","Select","Select",""],["","378718505","METFORMIN","TAB 500MG","360","Select","Select",""],["","8290324912","INSULIN SYRG","MIS 1ML\/31G","200","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","3","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","-30","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","60","Select","Select",""],["","8317700100","RELION PRIME","TES GLUCOSE","200","Select","Select",""],["","8290320122","BD PEN NEEDL","MIS 32GX4MM","-300","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","-30","Select","Select",""],["","65924007","DUREZOL","EMU 0.0005","5","Select","Select",""],["","24208044605","BESIVANCE","SUS 0.006","-5","Select","Select",""],["","29300012910","HYDROCHLOROT","TAB 50MG","-30","Select","Select",""],["","93026430","FLUOCINONIDE","OIN 0.0005","-120","Select","Select",""],["","2143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","-60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","-15","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","68682010710","NIFEDIPINE","TAB 90MG ER","30","Select","Select",""],["","169633910","NOVOLOG FLEXPEN ","","30","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN","","30","Select","Select",""],["","68645019159","METOPROLOL TARTRATE","","60","Select","Select",""],["","68645058259","METFORMIN HYDROCHLORIDE","","360","Select","Select",""],["","8290324912","BD VEO INSULIN SYRINGE ULTRA-FINE\/1ML\/31G X 6MM","","180","Select","Select",""],["","68645056854","ATORVASTATIN CALCIUM ","","30","Select","Select",""],["","29300012910","HYDROCHLOROTHIAZIDE","","30","Select","Select",""],["","456120130","LINZESS ","","30","Select","Select",""],["","45802005505","TRIAMCINOLONE ACETONIDE","","454","Select","Select",""],["","8290491201","BD INSULIN SYRINGE ULTRAFINE\/U-100\/1ML\/31G X 15\/64\" ","","180","Select","Select",""],["","31722070110","LOSARTAN POTASSIUM ","","30","Select","Select",""],["","169368712","LEVEMIR ","","30","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","","30","Select","Select",""],["","8317700050","RELION PRIME BLOOD GLUCOSE TEST STRIPS","","300","Select","Select",""],["","8290320122","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM","","100","Select","Select",""],["","2143480","TRULICITY ","","-2","Select","Select",""],["","11917004814","INSULIN SYRINGE\/0.5ML\/31G X 5\/16\" ","","200","Select","Select",""],["","65924007","DUREZOL ","","5","Select","Select",""],["","68682010710","NIFEDIPINE ER ","","30","Select","Select",""],["","24208044605","BESIVANCE ","","-5","Select","Select",""],["","8290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"","","-300","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN","","-15","Select","Select",""],["","29300012510","MELOXICAM ","","30","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","","30","Select","Select",""],["","08290491201","BD INSULIN SYRINGE ULTRAFINE\/U-100\/1ML\/31G X 15\/64\"","","180","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM","","30","Select","Select",""],["","68645056854","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","11917004814","INSULIN SYRINGE\/0.5ML\/31G X 5\/16\"","","-200","Select","Select",""],["","68682010710","NIFEDIPINE ER","","30","Select","Select",""],["","00169210125","NOVOLOG FLEXPEN RELION","","30","Select","Select",""],["","00169643910","LEVEMIR FLEXPEN","","30","Select","Select",""],["","73070010215","INSULIN ASPART PENFILL","","-15","Select","Select",""],["","00169330312","NOVOLOG PENFILL","","30","Select","Select",""],["","62088000034","INPEN 100\/BLUE\/NOVO","","1","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00363041414","ASPIRIN","81MG EC","90","Select","Select",""],["","68645058259","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","360","Select","Select",""],["","00093026430","FLUOCINONIDE                                                          ","OIN 0.0005","120","Select","Select",""],["","68645019159","METOPROLOL TARTRATE                                                   ","TAB 100MG","60","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM                                                    ","TAB 50MG","30","Select","Select",""],["","29300012910","HYDROCHLOROTHIAZIDE                                                   ","TAB 50MG","-30","Select","Select",""],["","08317700050","RELION PRIME BLOOD GLUCOSE TEST STRIPS                                ","TES ","250","Select","Select",""],["","08290324912","BD VEO INSULIN SYRINGE ULTRA-FINE\/1ML\/31G X 6MM                       ","MIS 1ML\/31G","-180","Select","Select",""],["","11917004814","INSULIN SYRINGE\/0.5ML\/31G X 5\/16\"                                     ","MIS 0.5\/31G","200","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE                                                   ","TAB 10MG","30","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 5-325MG","30","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN                                                       ","INJ FLEXPEN","30","Select","Select",""],["","00169368712","LEVEMIR                                                               ","INJ ","30","Select","Select",""],["","00456120130","LINZESS                                                               ","CAP 145MCG","30","Select","Select",""],["","55111012305","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","30","Select","Select",""],["","00002143480","TRULICITY                                                             ","INJ 1.5\/0.5","-2","Select","Select",""],["","08290320122","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM                              ","MIS 32GX4MM","-300","Select","Select",""],["","45802005505","TRIAMCINOLONE ACETONIDE                                               ","OIN 0.001","454","Select","Select",""],["","24208060203","PROLENSA                                                              ","SOL 0.0007","3","Select","Select",""],["","00065924007","DUREZOL                                                               ","EMU 0.0005","-5","Select","Select",""],["","08290491201","BD INSULIN SYRINGE ULTRAFINE\/U-100\/1ML\/31G X 15\/64\"                   ","MIS 1ML\/31G","180","Select","Select",""],["","24208044605","BESIVANCE                                                             ","SUS 0.006","-5","Select","Select",""],["","68682010710","NIFEDIPINE ER                                                         ","TAB 90MG ER","30","Select","Select",""],["","00316022115","NYSTATIN                                                              ","CRE 100000","-60","Select","Select",""],["","08290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"                                ","MIS 32GX5\/32","300","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN                                                ","INJ FLEXPEN","15","Select","Select",""],["","29300012510","MELOXICAM                                                             ","TAB 15MG","-30","Select","Select",""],["","73070010215","INSULIN ASPART PENFILL                                                ","INJ PENFILL","15","Select","Select",""],["","00169330312","NOVOLOG PENFILL                                                       ","INJ PENFILL","30","Select","Select",""],["","57237000511","FLUCONAZOLE                                                           ","TAB 150MG","3","Select","Select",""],["","62088000034","INPEN 100\/BLUE\/NOVO                                                   ","MIS BLUE","1","Select","Select",""],["","00169210125","NOVOLOG FLEXPEN RELION                                                ","INJ FLEXPEN","-30","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","1","Select","Select",""],["","00363041414","ASPIRIN                                                               ","TAB 81MG EC","90","Select","Select",""],["","00169643910","LEVEMIR FLEXPEN                                                       ","INJ FLEXPEN","30","Select","Select",""],["","00363058714","ASPIRIN 81                                                            ","TAB 81MG EC","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}