{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUTH E FISHER","gend":1,"add":"2830 AMBLER AVE. APT.A  ","city":"PORTSMOUTH  ","state":"VA","zip":"23707-4501","dob":"1952-05-11","age":"","mstatus":"","insh":11002272,"cliId":"9FJ1TN9AR09","pno":7579309269,"cno":7579309269,"email":"","ename":"","eno":"","pphy":"KAPUR, ANAND","ppno":7576735890,"pcpadd":"5818 Harbour View Blvd Ste 250","pcpcity":"Suffolk  ","pcpstate":"VA","pcpzip":234353317,"pcpcounty":"","pcpid":"P0060366","pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2830 AMBLER AVE. APT.A  ","madd2":"","madd3":"","mcity":"PORTSMOUTH  ","mstate":"VA","mzip":"23707-4501","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z51.11","C79.9","Z71.6","R52","Z68.32","C56.9","R91.8","C56.1","C56.2","Z68.30","I10","Z90.722","R19.09","R93.89","R93.3","E04.1","Z90.710","Z98.890","C79.89","G89.3","Z72.0","C80.1","C49.4","J45.909","R22.2","R94.8","Z79.82","Z79.899","C76.2","R23.2","E78.00","M25.561","Z96.651","M19.90","M54.5","M46.1","M70.61","G89.4","G89.29","M70.62","Z68.31","C44.92","N83.8","K76.0","C57.7","I70.0","M47.816","M54.9","Z12.31","J45.20","D64.9","J30.9","E87.6","F17.200","E66.9","R19.01","Z68.27","Z01.810","Z01.818","D39.9","R19.00","N28.1","Z96.652","M25.572","K63.5","E27.8","N32.3","C44.529","E78.5","F17.210","Z88.0","Z85.43","Z01.419","Z68.28","M51.36","R10.9","R68.89","Z00.00","I25.2","R94.31","Z68.29","M25.552","R60.9","I73.9","I71.4","Z68.33","I77.811","S32.020A","K59.00","Z71.89","R19.03","R19.04","R10.2","D49.89","D25.9","N83.202","R59.0","N85.4","M85.80","E86.0","N99.840","G40.909","S30.1XXA","T14.8XXA","X50.0XXA","Z51.12","A41.9","R65.21","N17.9","N39.0","D50.0","N93.9","T81.43XA","D62","E87.2","K68.11","E83.42","T81.4XXA","N73.9","T81.89XA","T81.31XA","R18.8","R10.819","Z45.2","B96.20","B95.2","Z51.81","Z79.2","R69","R53.1","Z13.31","Z12.39","I70.213","I70.211","M17.10","Z68.34","R21","Z68.35","R91.1","N94.89","M25.571","L30.9","L20.9","B35.3","L85.1"],"date":["2021-08-31","2021-11-22","2020-03-13","2020-04-27","2021-11-22","2021-10-11","2019-01-29","2019-02-18","2021-11-23","2019-02-01","2021-10-07","2019-02-14","2019-02-14","2019-02-14","2019-02-14","2019-02-14","2020-04-22","2019-12-05","2021-11-23","2021-03-24","2020-04-27","2021-11-23","2019-06-27","2019-12-05","2019-06-27","2019-03-08","2019-12-05","2019-12-05","2019-03-08","2019-03-11","2021-10-07","2019-06-13","2020-08-12","2019-12-05","2020-11-02","2019-03-12","2019-03-12","2021-10-07","2021-09-27","2019-03-12","2020-07-20","2021-03-24","2021-03-24","2020-04-22","2021-11-22","2020-08-20","2018-05-09","2018-05-09","2021-01-18","2021-06-22","2019-11-21","2019-11-21","2021-06-22","2021-09-27","2021-06-22","2019-06-27","2018-06-19","2019-05-29","2019-05-29","2020-06-04","2018-09-19","2021-08-28","2020-11-17","2020-06-23","2020-11-17","2018-06-27","2018-06-27","2019-06-27","2019-06-27","2020-09-23","2019-06-27","2021-10-15","2018-07-06","2018-12-14","2018-07-11","2020-09-01","2019-07-11","2020-11-17","2018-07-12","2018-09-10","2018-09-17","2020-09-22","2020-08-12","2020-10-07","2020-08-12","2021-07-19","2020-08-20","2020-08-20","2018-09-24","2020-11-17","2018-09-13","2018-09-13","2018-09-13","2018-09-14","2018-09-14","2018-09-14","2018-09-14","2018-09-14","2021-07-15","2018-09-24","2018-09-24","2018-09-17","2018-09-19","2018-09-17","2018-09-17","2021-11-23","2018-10-31","2018-10-31","2018-10-03","2018-09-25","2018-09-25","2018-10-04","2018-09-24","2018-09-24","2018-10-03","2018-09-24","2018-09-24","2018-09-24","2018-10-26","2018-09-24","2018-09-24","2018-09-25","2018-09-29","2019-12-12","2018-10-05","2018-10-05","2018-10-05","2018-10-05","2018-10-09","2018-11-05","2019-11-21","2019-11-21","2021-06-22","2020-10-07","2020-10-14","2021-01-27","2021-11-23","2021-03-15","2021-03-24","2021-08-28","2021-08-19","2021-10-07","2021-06-22","2021-09-28","2021-09-28"],"priorHcc":["",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":[["","591207030","LIDO\/PRILOCN","CRE 2.5-2.5%","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","51672402701","WARFARIN","TAB 1MG","","Select","Select",""],["","781572005","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","245531915","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","406012301","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","173052100","SEREVENT DIS","AER 50MCG","","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","406051201","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","","Select","Select",""],["","51672402701","WARFARIN ","TAB 1MG","90","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","591207030","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","57237007810","ONDANSETRON ","TAB 8MG ODT","60","Select","Select",""],["","781572005","POT  CL MICRO","TAB 20MEQ ER","34","Select","Select",""],["","245531915","KLOR-CON ","TAB 20MEQ ER","60","Select","Select",""],["","173052100","SEREVENT ","AER 50MCG","60","Select","Select",""],["","406012301","HYDROCO\/APAP ","TAB 5-325MG","21","Select","Select",""],["","406051201","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","52817018000","CLONIDINE ","TAB 0.1MG","12","Select","Select",""],["","31722070430","VALACYCLOVIR ","TAB 500MG","10","Select","Select",""],["","168008031","HYDROCORT ","2.50%","30","Select","Select",""],["","51672135004","CLOBETASOL ","0.0005","118","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","69097094307","GABAPENTIN ","300MG","60","Select","Select",""],["","00245531915","KLOR-CON","20MEQ ER","60","Select","Select",""],["","52565002285","ECONAZOLE","0.01","85","Select","Select",""],["","51672135004","CLOBETASOL","0.0005","118","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","00173052100","SEREVENT","50MCG","60","Select","Select",""],["","69097094307","GABAPENTIN","300MG","60","Select","Select",""],["","00168008031","HYDROCORT","0.025","30","Select","Select",""],["","44523061707","UREA","40%","198.4","Select","Select",""],["","51672130308","ECONAZOLE ","CRE 0.01","85","Select","Select",""],["","44523061707","UREA ","CRE 0.4","198.4","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}