{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  EILSELESUOH R ","gend":0,"add":"EHC 5025EVA TUNS","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1964-10-12","age":"","mstatus":"","insh":"94000910*002","cliId":"","pno":"4575712746","cno":"","email":"","ename":"","eno":"","pphy":"HUFFMAN, FRANK H MD","ppno":7575387275,"pcpadd":"1540 BREEZEPORT WAY SUITE 100","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC","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","Z79.4","Z79.899","E66.9","Z68.38","E78.5","I10.","Z87.891","H25.812","E11.3292","H25.11","Z68.37","E78.00","M11.20","M19.041","Z79.1","M19.042","Z51.81","E11.9","M11.262","M17.0","M11.261","Z12.11","F41.9","F32.A","Z88.8","Z88.0","Z79.890","M25.561","M25.562","G89.29","F32.9","K21.9","M89.49","E03.9","Z00.00","N32.81","H35.352","D84.821","E11.40","Z79.85","H25.811","S01.511A","Z68.36","E11.65","H25.813","Z79.84","F41.8","M19.90","H25.12","Z68.35","Z91.14","Z00.01","Z13.220","Z02.83"],"date":["2023-03-22","2023-03-29","2022-12-22","2022-07-19","2021-10-20","2022-06-01","2023-03-07","2022-07-19","2022-06-28","2022-07-29","2022-04-13","2022-11-21","2023-03-07","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2023-03-07","2023-03-15","2021-09-27","2021-09-27","2021-09-27","2022-05-28","2023-03-07","2023-03-07","2022-06-28","2022-06-28","2022-06-28","2021-09-27","2022-12-05","2021-09-27","2021-09-24","2022-11-21","2022-01-08","2022-06-01","2022-12-01","2023-03-07","2022-10-31","2022-01-25","2022-01-25","2023-03-29","2022-10-31","2022-11-19","2023-03-07","2023-03-29","2022-03-29","2022-04-27","2022-06-28","2021-10-25","2022-06-28","2022-07-19","2023-02-14","2023-03-07","2023-03-07","2023-03-07"],"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":[["","00310653004","BYDUREON PEN","INJ 2MG","12","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00310654004","BYDUREON BC","INJ 2\/0.85ML","3","Select","Select",""],["","62332014231","CELECOXIB","CAP 200MG","180","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","7","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","43598029490","PREGABALIN","100 MG","60","Select","Select",""],["","72305007530","EUTHYROX","TAB 75MCG","90","Select","Select",""],["","69584009350","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","165","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","90","Select","Select",""],["","81131038681","RELION PEN","MIS 31GX8MM","100","Select","Select",""],["","00169413013","OZEMPIC","1\/0.75 (3)","3","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","180","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","400","Select","Select",""],["","00527495432","LEVOTHYROXIN","CAP 75MCG","90","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","13107015590","PAROXETINE","TAB 20MG","90","Select","Select",""],["","00591034301","VERAPAMIL","TAB 80MG","90","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","180","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","62332002991","LOSARTAN POT","TAB 100MG","90","Select","Select",""],["","43547030203","ARIPIPRAZOLE","2 MG","30","Select","Select",""],["","69584009350","BUSPIRONE HCL","15 MG","120","Select","Select",""],["","68462038730","SOLIFENACIN SUCCINATE","10 MG","90","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","60505384901","CELECOXIB CAP","200MG","180","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00310654004","BYDUREON BC INJ","2\/0.85ML","3","Select","Select",""],["","43598072101","HYDROXYCHLOR TAB","200MG","180","Select","Select",""],["","00310653004","BYDUREON PEN INJ","2MG","12","Select","Select",""],["","00002143480","TRULICITY INJ","1.5\/0.5","2","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","-400","Select","Select",""],["","69584009350","BUSPIRONE TAB","15MG","60","Select","Select",""],["","00169413013","OZEMPIC INJ","4MG\/3ML","9","Select","Select",""],["","00591034301","VERAPAMIL TAB","80MG","270","Select","Select",""],["","81131038681","RELION PEN MIS","31GX8MM","100","Select","Select",""],["","68462038730","SOLIFENACIN TAB","10MG","90","Select","Select",""],["","72305007530","EUTHYROX TAB","75MCG","90","Select","Select",""],["","70377003012","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","43598029490","PREGABALIN CAP","100MG","90","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","7","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","165","Select","Select",""],["","00378180510","LEVOTHYROXIN TAB","75MCG","90","Select","Select",""],["","13107015590","PAROXETINE TAB","20MG","90","Select","Select",""],["","61314063710","PREDNISOLONE SUS","1% OP","10","Select","Select",""],["","62332002991","LOSARTAN POT TAB","100MG","90","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","70954000520","OXYBUTYNIN TAB","5MG","180","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","90","Select","Select",""],["","00527495432","LEVOTHYROXIN CAP","75MCG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","43547030203","ARIPIPRAZOLE TAB","2MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","400","Select","Select",""],["","62332002991","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","13107015590","PAROXETINE HCL","20 MG","90","Select","Select",""],["","70377003012","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","70954000520","OXYBUTYNIN CHLORIDE","5 MG","180","Select","Select",""],["","00378180510","LEVOTHYROXINE SODIUM","75 MCG","90","Select","Select",""],["","00591034301","VERAPAMIL HCL","80 MG","270","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","60","Select","Select",""],["","49502025175","SEMGLEE (YFGN) PEN","100\/ML (3)","15","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","200","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":""}]}]}