{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ALIEHSNOSNHOJ A","gend":1,"add":"EIFMRA 0077543 EVA DL","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1950-12-17","age":"","mstatus":"","insh":"73000910*552","cliId":"","pno":"53\/7571293-1","cno":"","email":"","ename":"","eno":"","pphy":"CAHILL, BETHANY NP","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LN STE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","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":["E11.42","E78.00","E03.9","Z85.048","Z93.3","Z85.3","Z74.09","R06.02","Z11.59","Z79.4","Z43.3","L84.","R07.9","I10.","Z68.35","C50.512","Z00.00","H61.22","Z68.36","R82.90","N32.81","Z01.818","Z12.11","Z86.010","C21.0","E11.9","N18.3","H92.02","Z17.1","I50.9","Z68.33","M20.41","R20.2","M20.42","N64.4","Z90.12","Z92.3","N18.32","I42.9","Z78.0","H61.23","M81.0","Z23.","H49.9","R27.0","E11.69","E78.2","M85.89","C50.912","R26.89","C50.919","N18.31","F51.01","R92.8","R35.0","E11.21","E11.3393","Z96.1","H02.423","H43.813","E78.5","I25.10","E11.36","E11.51","I12.9","E11.22","R31.9","E10.40","Z92.21","E10.49","E10.3599","Z86.718","Z79.890","Z79.899","Z88.1","Z88.8","I51.7","M79.622","Z98.890","Z91.041","E04.9","M19.071","M19.072","R42.","E11.40","Z86.73","I63.9","E11.39","H49.40","I63.219","N18.30","N30.00","R55.","H49.21","E66.9","R29.703","B96.20","Z20.822","R51.9","J01.30","Z09.","D63.1","J32.3","I26.99","M62.81","Z68.30","I63.50","R26.9","R29.3","I13.10","H26.9","Z74.3","S04.41XA","W19.XXXA","I65.01","I63.89","H51.20","H50.51","E11.3593","H57.13","J34.89","R29.90","G44.229","R26.0","M79.673","I69.398","R29.818","H53.8","Z79.82","H92.09","H43.11","H35.371","H51.23","Z98.42","Z98.41","Z12.31","E11.3513","Z91.09","M20.22","N39.0","Z71.89","Z68.29","Z66.","R39.89"],"date":["2022-07-21","2022-01-13","2022-09-04","2022-01-19","2022-06-27","2022-02-25","2020-10-15","2020-10-15","2020-07-15","2022-09-04","2022-06-27","2020-12-30","2022-01-19","2022-11-01","2021-05-03","2021-09-28","2022-07-21","2020-06-03","2021-03-18","2020-06-03","2021-05-03","2020-07-15","2020-07-17","2020-07-17","2022-05-24","2022-11-01","2020-07-06","2020-07-06","2021-09-28","2021-07-20","2021-12-20","2020-11-19","2022-06-30","2020-11-19","2021-11-08","2020-12-28","2022-07-12","2022-01-13","2022-01-13","2021-09-07","2021-08-03","2021-09-14","2021-09-14","2022-01-13","2022-02-02","2021-12-24","2021-12-24","2021-09-07","2021-11-01","2022-07-25","2021-09-01","2021-05-03","2021-05-03","2021-11-08","2020-10-15","2022-11-01","2021-08-13","2022-07-12","2021-08-13","2021-08-13","2022-11-01","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-12-20","2020-01-21","2022-09-04","2022-01-19","2020-07-17","2020-07-17","2022-01-19","2020-07-17","2022-09-04","2022-09-04","2022-09-04","2021-12-21","2021-11-08","2022-01-19","2022-09-04","2021-09-07","2022-06-30","2021-11-30","2022-09-04","2022-07-12","2022-07-12","2021-12-23","2021-12-24","2021-12-24","2022-11-01","2022-11-01","2022-11-01","2022-08-04","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2022-09-04","2021-12-20","2022-01-13","2021-12-30","2021-12-20","2022-01-19","2022-07-25","2022-03-03","2022-03-16","2021-12-24","2021-12-24","2021-12-24","2021-12-24","2022-08-04","2021-12-20","2022-01-19","2022-03-16","2022-03-16","2022-02-25","2022-02-25","2022-07-12","2022-05-17","2022-03-03","2022-09-04","2022-04-19","2022-04-19","2022-04-19","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-06-15","2022-07-12","2022-07-12","2022-06-30","2022-07-21","2022-07-21","2022-07-21","2022-07-21","2022-07-21"],"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":[["","00487990130","ALBUTEROL SULFATE","NEB 0.005","15","Select","Select",""],["","68180096801","LEVOTHYROXINE SODIUM","TAB 88MCG","90","Select","Select",""],["","69238131409","PREGABALIN","CAP 150MG","180","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","AER HFA","8","Select","Select",""],["","68180063809","ATORVASTATIN CALCIUM","TAB 80MG","90","Select","Select",""],["","67877056105","METFORMIN HYDROCHLORIDE","TAB 500MG","180","Select","Select",""],["","11822334910","RA EAR DROPS","DRO 6.5% OT","30","Select","Select",""],["","57237001830","DULOXETINE HYDROCHLORIDE","CAP 30MG","90","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","08290324912","BD VEO INSULIN SYRINGE ULTRA-FINE\/1ML\/31G X 6MM","MIS 1ML\/31G","180","Select","Select",""],["","00002871501","HUMULIN 70\/30","INJ 70\/30","90","Select","Select",""],["","00169413013","OZEMPIC","INJ 4MG\/3ML","9","Select","Select",""],["","08290320749","BD PEN NEEDLE\/MICRO\/ULTRA-FINE\/32G X 6MM","MIS 32GX6MM","-90","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","-1","Select","Select",""],["","65162037210","OXYBUTYNIN CHLORIDE ER","TAB 10MG ER","90","Select","Select",""],["","68382009201","CARVEDILOL","TAB 3.125MG","180","Select","Select",""],["","00169185189","NOVOFINE 32GX6MM","MIS 32GX6MM","90","Select","Select",""],["","70010010801","GABAPENTIN","CAP 100MG","-279","Select","Select",""],["","16714063301","ALENDRONATE SODIUM","TAB 70MG","12","Select","Select",""],["","42037010478","DEBROX","SOL 6.5% OT","30","Select","Select",""],["","56151014260","TRUEPLUS LANCETS 28G","MIS 28G","100","Select","Select",""],["","21292000616","TRUE METRIX BLOOD GLUCOSETEST STRIPS","TES GLUCOSE","100","Select","Select",""],["","51660093901","CETIRIZINE HYDROCHLORIDE","TAB 10MG","90","Select","Select",""],["","08290491201","BD VEO INSULIN SYRINGE ULTRA-FINE\/U-100\/1ML\/31G X 15\/64\"","MIS 1ML\/31G","-180","Select","Select",""],["","61314012605","KETOROLAC TROMETHAMINE","SOL 0.005","5","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","56151149002","TRUE METRIX AIR BLOOD GLUCOSE METER\/BLUETOOTH SMART","KIT AIR","-1","Select","Select",""],["","00067203991","EXCEDRIN MIGRAINE","TAB MIGRAINE","90","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE","INJ COVID-19","0","Select","Select",""],["","08489600310","DROPLET INSULIN SYRINGE U-100\/1ML\/31G X 15\/64\"","MIS 1ML\/31G","-180","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":""}]}]}