{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAZEL PERDUE","gend":1,"add":"2705 CICERO PARKWAY  ","city":"CHESTER  ","state":"VA","zip":"23831-5202","dob":"1949-03-18","age":"","mstatus":"","insh":11000040,"cliId":"9DF1A66VN13","pno":8042978961,"cno":8048989108,"email":"","ename":"","eno":"","pphy":"BECKWITH, DOUGLAS E  ","ppno":8047962373,"pcpadd":"12901 Briggs Rd","pcpcity":"Chester  ","pcpstate":"VA","pcpzip":238315335,"pcpcounty":"","pcpid":"P0060159","pcpname":"CHESTER FAMILY MEDCARE PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2705 CICERO PARKWAY  ","madd2":"","madd3":"","mcity":"CHESTER  ","mstate":"VA","mzip":"23831-5202","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G47.33","G25.81","I10","E78.5","F33.1","N18.3","N25.0","E11.9","D64.9","N39.0","R10.2","J32.9","I25.10","N81.10","M79.672","M20.42","M20.41","M67.01","M67.02","M77.42","Z01.419","Z12.31","R10.9","N25.81","E55.9","R80.8","J06.9","G47.00","R11.0","N28.1","E87.2","R56.9","G40.409","E87.6","I67.89","R00.0","Q79.1","R10.32","R15.1","H25.12","Z96.1","H04.123","H43.811","G44.209","K21.9","E66.3","F33.41","F41.9","G47.30","J45.909","R09.81","Z68.26","Z79.84","Z79.899","Z87.891","Z99.89","F90.9","G40.89","D72.829","G40.909","R15.9","E78.2","Z82.49","H61.22","H91.93","H90.3","R51","F32.9","J30.1","R35.1","R35.0","Z72.820","F41.8","J45.20","E87.5","J34.2","J45.901","J30.9","H35.373","H26.491","R06.00","R06.02","F43.23","H01.002","H01.005","H10.31","S30.0XXA","N39.3","R30.9","J44.9","Z23","L30.9","T78.40XA","E03.9","M19.90","Z79.82","Z83.3","Z88.2","Z88.5","Z91.040","M54.5","Z12.11","F17.211","Z68.27","Z68.25","R07.9","R07.89","M54.16","R10.31","M79.604","W18.30XA","N28.9","M51.36","I21.29","Z20.828","M53.86","Z00.00","Z13.31","Z13.39","R42","R90.82","M25.69","R29.3","I12.9","N18.30","E11.22","E11.65","Z20.822","Z91.14","R11.10","I35.8","I34.8","M95.5","Z91.81","H02.883","H02.885","R19.7","Z09","R05","R19.4","R10.30","R13.10","K11.20","K59.00","M62.81","R07.1","I45.19","Z01.812","K57.30","D12.3","K22.4","E78.00","D12.2","N30.01","I70.211","J45.40","M54.41","G89.29","M54.42","R09.82"],"date":["2020-06-02","2019-01-07","2021-09-18","2021-02-23","2019-03-04","2020-09-17","2020-01-16","2021-09-18","2020-09-14","2020-11-10","2020-01-17","2019-01-18","2021-07-15","2018-09-18","2018-01-30","2018-01-30","2018-01-30","2018-01-30","2018-01-30","2018-01-30","2020-02-04","2021-03-15","2020-11-27","2020-09-14","2020-11-04","2020-02-06","2021-02-23","2020-06-02","2021-02-23","2019-02-11","2020-02-13","2021-09-15","2020-03-27","2020-02-13","2020-02-12","2021-09-15","2020-02-12","2019-10-09","2019-03-14","2021-04-20","2019-07-03","2021-03-03","2018-03-01","2019-05-14","2021-09-29","2018-03-21","2018-03-21","2021-06-16","2018-03-21","2021-09-29","2018-03-21","2018-03-21","2021-09-29","2021-09-29","2021-09-29","2018-03-21","2020-03-27","2020-03-27","2020-03-27","2020-12-09","2019-03-28","2021-06-16","2021-04-07","2019-04-17","2019-04-17","2019-04-17","2019-05-11","2020-11-03","2019-11-11","2020-11-10","2020-05-26","2021-01-27","2021-06-16","2020-11-03","2020-09-17","2018-05-29","2020-06-02","2021-09-22","2021-04-20","2019-07-03","2021-02-24","2019-08-02","2019-10-10","2019-08-22","2019-08-22","2019-08-30","2019-09-11","2018-09-18","2019-10-01","2017-10-03","2019-11-11","2019-10-18","2019-10-21","2021-09-29","2019-11-07","2021-09-29","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2021-04-01","2021-09-29","2019-11-11","2021-06-16","2020-11-19","2020-11-19","2020-11-19","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2021-04-01","2020-12-09","2021-02-23","2021-02-09","2021-01-27","2021-01-27","2021-01-27","2021-02-24","2021-02-23","2020-12-31","2020-12-31","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-09-24","2021-02-23","2021-02-23","2021-02-24","2021-02-24","2021-04-01","2021-04-01","2021-03-03","2021-03-03","2021-06-16","2021-03-15","2021-09-10","2021-09-29","2021-03-17","2021-09-29","2020-08-28","2021-06-18","2020-12-31","2021-02-15","2021-09-15","2021-09-24","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-10-07","2021-10-11","2021-11-02","2021-06-16","2021-06-16","2021-06-16","2021-11-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","55111013030","RANITIDINE","CAP 300MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","98302000160","ULTRA THIN","MIS 31G","","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","","Select","Select",""],["","43547030203","ARIPIPRAZOLE","TAB 2MG","","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","","Select","Select",""],["","591544310","PREDNISONE","TAB 20MG","","Select","Select",""],["","193725201","CONTOUR","KIT NEXT EZ","","Select","Select",""],["","98302000105","ALCOHOL PREP","PAD ","","Select","Select",""],["","193731401","CONTOUR NEXT","SOL LEVEL 2","","Select","Select",""],["","60913000101","AQUALANCE","MIS 30G","","Select","Select",""],["","193711001","CONTOUR LOW","LIQ CONTROL","","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","68180095601","CLOBETASOL","CRE 0.0005","","Select","Select",""],["","98302000100","SIMPLE DIAG","MIS LANCING","","Select","Select",""],["","70461001903","FLUAD","INJ 2019-20","","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","378877035","ESTRADIOL","CRE 0.0001","","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","","Select","Select",""],["","43547029010","BUPROPION","TAB 200MG SR","","Select","Select",""],["","24208029505","TOBRA\/DEXAME","SUS 0.3-0.1%","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","94030000202","EMBRACE","TES BLD GLUC","","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","TAB 2MG","30","Select","Select",""],["","70377000812","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","13107008405","LORAZEPAM ","TAB 1MG","30","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","55111013030","RANITIDINE ","CAP 300MG","90","Select","Select",""],["","98302000160","ULTRA ","MIS 31G","100","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","59746012206","MECLIZINE ","TAB 12.5MG","15","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","93005805","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","378877035","ESTRADIOL ","CRE 0.0001","42.5","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","591544310","PREDNISONE ","TAB 20MG","21","Select","Select",""],["","67877025115","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","70010049110","METFORMIN ","TAB 500MG ER","180","Select","Select",""],["","115544513","BUPROPION ","TAB 200MG SR","90","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","68180095601","CLOBETASOL ","CRE 0.0005","15","Select","Select",""],["","193709021","CONTOUR ","TES BLD GLUC","100","Select","Select",""],["","60913000101","AQUALANCE ","MIS 30G","100","Select","Select",""],["","98302000100","SIMPLE ","MIS LANCING","1","Select","Select",""],["","98302000105","ALCOHOL ","PAD ","100","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","5","Select","Select",""],["","70461001903","FLUAD ","INJ 2019-20","0.5","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","90","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","24208029505","TOBRA\/DEXAME ","SUS 0.3-0.1%","10","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","180","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","310737020","BUDES\/FORMOT ","160-4.5","30.6","Select","Select",""],["","94030000202","EMBRACE ","BLD GLUC","100","Select","Select",""],["","51991074690","DULOXETINE ","20MG","90","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","1.5","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","98302000160","ULTRA","31G","100","Select","Select",""],["","00093005805","TRAMADOL","50MG","10","Select","Select",""],["","68180065208","DOXYCYC","100MG","14","Select","Select",""],["","98302000105","ALCOHOL","","100","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","98302000100","SIMPLE","LANCING","1","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","1.5","Select","Select",""],["","43386005019","GAVILYTE-N","FLAV PK","4,000.00","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","66685100200","AMOX\/K","500-125","14","Select","Select",""],["","51991074690","DULOXETINE","20MG","90","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","68462011940","FLUCONAZOLE","150MG","1","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","20","Select","Select",""],["","68462011940","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00173085910","BREO ","INH 100-25","60","Select","Select",""],["","43386005019","GAVILYTE-N ","SOL FLAV PK","4,000.00","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","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":""}]}]}