{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J   XILEFSLLEVIS ","gend":0,"add":"RB 104RD ASI","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1944-04-11","age":"","mstatus":"","insh":"35000910*086","cliId":"","pno":"6575769700","cno":"","email":"","ename":"","eno":"","pphy":"SNELLINGS, JOHN E MD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","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":["R26.81","H60.42","I50.22","I25.10","I11.9","E78.5","Z47.1","Z96.661","J43.9","R91.1","R52.","D50.0","M20.21","M20.41","M20.42","H60.91","Z00.00","Z13.31","I10.","R22.0","J45.20","R91.8","J43.2","Z90.49","E55.9","R55.","N18.9","Z01.818","R60.0","Z86.79","H61.891","H90.3","R25.1","D50.8","Z79.82","Z79.899","Z82.49","J30.89","J39.2","Z20.822","G47.33","R22.43","Z96.652","E78.00","I11.0","I50.9","Z95.5","J44.9","G47.30","R60.9","I48.0","I50.32","R73.03","H60.391","H61.22","I49.1","I49.3","R06.02","M79.89","Z01.810","M62.81","H92.01","H60.8X3","I48.20","F10.21","E66.3","Z79.51","Z79.01","Z74.09","Z74.1","Z99.89","Z99.3","Z71.89","Z87.39","Z68.27","R06.09","J30.9"],"date":["2022-11-28","2023-02-23","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2022-05-27","2022-05-27","2022-12-14","2022-05-24","2022-08-29","2022-04-05","2022-08-29","2022-08-29","2022-06-27","2022-11-10","2022-12-02","2022-12-02","2022-12-14","2022-01-12","2022-05-24","2022-02-09","2022-02-09","2022-02-09","2023-01-23","2023-01-23","2023-01-23","2022-05-17","2023-02-28","2022-04-28","2022-12-05","2022-11-10","2022-11-28","2022-11-28","2022-12-14","2022-12-14","2022-02-18","2022-06-30","2022-06-30","2022-08-03","2022-05-27","2022-03-01","2022-05-27","2022-05-27","2022-05-27","2022-12-14","2022-05-27","2022-05-27","2022-05-24","2022-05-13","2022-09-29","2023-01-23","2023-01-23","2022-12-05","2022-11-02","2022-02-18","2022-02-18","2022-02-18","2022-03-08","2022-05-19","2023-01-03","2023-02-23","2023-02-23","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2023-01-23","2023-02-28"],"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":[["","64980056210","FUROSEMIDE","20 MG","90","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","10","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","24","Select","Select",""],["","76204060005","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","00310461612","BREZTRI AERO","AER SPHERE","11","Select","Select",""],["","00078077720","ENTRESTO","49 MG-51MG","180","Select","Select",""],["","31722088530","ROSUVASTATIN","CAL CIUM 40 MG","90","Select","Select",""],["","62332003131","ROPINIROLE","TAB 0.5MG","90","Select","Select",""],["","68462016205","CARVEDILOL","3.125 MG","180","Select","Select",""],["","68382013516","LOSARTAN POT","TAB 25MG","90","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","180","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","24208063110","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","49281012265","FLUZONE HD","INJ 2022-23","1","Select","Select",""],["","69238137403","TOBRA\/DEXAME","SUS 0.3-0.1%","10","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","68462025401","ROPINIROLE HC","L 0 .5 MG","90","Select","Select",""],["","69097052444","DICLOFENAC SO","DIU M 1 %","100","Select","Select",""],["","68462016205","CARVEDILOL 3.","125 MG","180","Select","Select",""],["","60505082901","FLUTICASONE P","ROP IONATE 50 MCG","48","Select","Select",""],["","69452015120","VITAMIN D2 12","50 MCG","13","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","12","Select","Select",""],["","62332003131","ROPINIROLE TAB","0.5MG","90","Select","Select",""],["","76204060005","IPRATROPIUM\/ SOL ALBUTER","","360","Select","Select",""],["","00310461612","BREZTRI AERO AER SPHERE","","11","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","60","Select","Select",""],["","00904759160","FEROSUL TAB","325MG","180","Select","Select",""],["","00078065920","ENTRESTO TAB","24-26MG","180","Select","Select",""],["","64980051505","OFLOXACIN DRO","0.3% OP","10","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","48","Select","Select",""],["","68382009205","CARVEDILOL TAB","3.125MG","180","Select","Select",""],["","59762444002","METHYLPRED TAB","4MG","21","Select","Select",""],["","65862029630","ROSUVASTATIN TAB","40MG","90","Select","Select",""],["","21922000909","DICLOFENAC GEL","1%","100","Select","Select",""],["","62332003131","ROPINIROLE HCL","0.5 MG","90","Select","Select",""],["","68382013516","LOSARTAN POT TAB","25MG","90","Select","Select",""],["","00406012301","HYDROCO\/APAP TAB","5-325MG","42","Select","Select",""],["","00069108530","PAXLOVID TAB","300-100","30","Select","Select",""],["","24208063110","NEO\/POLY\/HC SOL","1% OTIC","10","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","69238137403","TOBRA\/DEXAME SUS","0.3-0.1%","10","Select","Select",""],["","65862029690","ROSUVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","49281012265","FLUZONE HD INJ","2022-23","1","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","48","Select","Select",""],["","68382005005","MELOXICAM","7.5 MG","30","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":""}]}]}