{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY D CARTER","gend":1,"add":"1049 W 37TH STREET","city":"NORFOLK  ","state":"VA","zip":"23508-2611","dob":"1950-09-21","age":"","mstatus":"","insh":11008206,"cliId":"3FG3PT9NU99","pno":7577172366,"cno":7577172366,"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":"1049 W 37TH STREET","madd2":"","madd3":"","mcity":"NORFOLK  ","mstate":"VA","mzip":"23508-2611","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E11.9","E78.00","J20.9","J45.909","J44.1","R39.81","E78.5","Z86.73","R05","Z87.891","R06.02","R06.2","R07.9","R53.83","G47.00","J44.9","Z12.31","I63.9","I60.7","R51","R41.89","I67.1","Z98.890","F17.210","Z01.89","Z11.59","Z98.2","Z79.4","Z79.1","Z79.899","Z79.51","G93.2","M47.9","M54.2","M19.90","A41.89","J12.89","U07.1","J96.01","D63.8","E11.65","K21.9","J43.9","T38.0X5A","Z79.82","J81.1","R91.8","Z20.828","Z74.3","A41.9","R09.02","R73.9","R19.00","E11.8","J96.21","I69.051","Z99.81","J18.9","L89.302","R52","M47.816","I70.0","Z96.89","M48.061","Z23","I50.9","M54.5","E16.2","N76.0","B96.89","J84.9","R63.4","J45.21","R09.89","Z79.2","Z86.79","R63.5","R60.9","R09.81","Z79.84","H53.462","H40.1113","H40.1122","M25.562","I72.0"],"date":["2021-11-28","2021-09-02","2021-09-02","2020-01-08","2021-09-02","2020-12-03","2021-11-17","2020-09-06","2020-01-31","2020-01-31","2020-07-16","2020-07-16","2020-01-31","2020-07-21","2020-04-16","2020-04-16","2020-11-25","2020-02-17","2021-09-02","2020-06-03","2020-07-16","2020-06-18","2020-07-24","2020-06-18","2020-06-18","2020-07-02","2020-07-02","2020-09-06","2020-09-06","2020-07-07","2020-07-07","2020-07-07","2020-07-09","2020-07-09","2020-07-09","2020-12-03","2020-07-23","2020-09-06","2020-09-06","2020-07-24","2020-07-16","2020-07-16","2020-09-09","2020-07-16","2020-07-16","2020-09-06","2020-07-16","2020-07-21","2020-07-16","2020-09-17","2020-07-16","2020-08-12","2020-07-24","2020-07-20","2020-07-25","2020-09-06","2020-09-06","2020-09-06","2020-09-09","2020-09-09","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-09-09","2020-12-03","2020-12-03","2020-10-08","2019-10-03","2019-10-03","2020-12-03","2020-10-08","2019-11-08","2019-11-08","2019-11-08","2019-11-08","2020-12-03","2020-12-03","2019-12-20","2019-12-20","2019-12-31","2021-10-21","2021-10-21","2021-03-04","2021-10-21"],"priorHcc":[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":[["","13107000334","MIRTAZAPINE","TAB 30MG","","Select","Select",""],["","597007541","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","55111012405","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","59762033302","LATANOPROST","SOL 0.00005","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","54001925","PREDNISONE","TAB 50MG","","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","88222033","LANTUS","INJ 100\/ML","","Select","Select",""],["","58160084211","BOOSTRIX","INJ ","","Select","Select",""],["","69097084905","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","5197102","PREVNAR 13","INJ ","","Select","Select",""],["","54429731","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","45963067711","METOPROL SUC","TAB 100MG ER","","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","11917001487","INSULIN SYRG","MIS 1ML\/29G","","Select","Select",""],["","56151014401","TRUPLUS LANC","MIS 30G","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","","Select","Select",""],["","60505014102","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","99073070822","FREESTYLE","TES LITE","","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","33342005407","PIOGLITAZONE","TAB 15MG","","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","73070010011","INSULIN ASPA","INJ 100\/ML","","Select","Select",""],["","29300013510","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","169750111","NOVOLOG","INJ 100\/ML","","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","65862020399","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","13107000334","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","SOL ALBUTER","270","Select","Select",""],["","597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","55111012405","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","90","Select","Select",""],["","93727156","PIOGLITAZONE ","TAB 15MG","90","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","59762033302","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","45963067711","METOPROL ","TAB 100MG ER","180","Select","Select",""],["","58160084211","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","90","Select","Select",""],["","88222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","200","Select","Select",""],["","56151014401","TRUPLUS ","MIS 30G","200","Select","Select",""],["","73070010011","INSULIN ","INJ 100\/ML","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","54001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","69097084905","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","5197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","54429731","FUROSEMIDE ","TAB 20MG","15","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","180","Select","Select",""],["","29300013510","CLONIDINE ","TAB 0.1MG","90","Select","Select",""],["","60505014102","GLIPIZIDE ","TAB 5MG","360","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","10","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","169750111","NOVOLOG ","INJ 100\/ML","20","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","68462010805","TOPIRAMATE ","25MG","90","Select","Select",""],["","73070010011","INSULIN","100\/ML","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","65862020399","LOSARTAN","100MG","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","45963067711","METOPROL","100MG ER","180","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","200","Select","Select",""],["","56151014401","TRUPLUS","30G","200","Select","Select",""],["","68462010805","TOPIRAMATE","25MG","90","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00005197102","PREVNAR","","0.5","Select","Select",""],["","42806031250","DOXYCYCL","100MG","14","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","400","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","400","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":""}]}]}