{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA A BAUMANN","gend":1,"add":"20148 MINK FARM RD","city":"ONANCOCK","state":"VA","zip":"23417-9998","dob":"1937-07-04","age":"","mstatus":"","insh":11010628,"cliId":"5CC4CD9JD62","pno":7577871304,"cno":7577871549,"email":"","ename":"","eno":"","pphy":"PERRY, ANGELICA ","ppno":7574426600,"pcpadd":"9524 HOSPITAL AVENUE, ","pcpcity":"NASSAWADOX","pcpstate":"VA","pcpzip":234131820,"pcpcounty":"","pcpid":"P9443118","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"PO BOX 968 ONLEY","add3":"","madd1":"PO BOX 968","madd2":"","madd3":"","mcity":"ONLEY ","mstate":"VA","mzip":"23418-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R39.81","R15.9","M62.81","K62.5","K92.2","D64.9","D64.89","J44.9","I10","E03.9","E78.5","Z91.81","Z87.891","Z79.02","Z79.82","Z79.899","Z99.81","R06.02","R05","R68.89","J44.1","J96.11","I50.42","K62.3","K59.00","I25.10","I50.20","Z79.01","J43.1","I11.0","M35.3","F41.9","K21.9","R07.9","Z23","E53.8","N30.90","F32.9","Z82.49","Z88.1","Z88.8","N39.0","B96.89","Z20.828","I73.9","I49.3","D51.9","D50.0","R10.9","R91.1","J90","E07.9","R06.2","M54.9","R00.0","R91.8","M54.6","R94.31","D53.9","E86.0","R19.7","R19.5","R53.1","I44.0","J40","E66.9","N30.00","I49.1","J44.0","R21","M47.22","R11.0","R63.0","M54.12","R51.9","R53.83","I25.2","Z00.00","M75.22","J98.11","R42","J96.10","Z20.822","E78.00","E55.9","Z99.3","R11.2","K56.600","K56.7","J18.9","R10.12","J98.4","I48.91","R06.00","R10.84","I48.0","I12.9","N18.30","M85.80","M16.0","I27.20","Z66","Z79.51","R26.2","I70.0","I51.89","I37.1","I08.3","Z79.52","I42.9","Z87.19","T14.8XXA","A41.9","N17.9","I50.22","I13.0","J43.9","R11.10","R50.9","Z90.49","M46.1","J20.9","R07.89","K31.89","I48.92","I48.11","J98.6","Z51.89","S22.32XD","S22.42XA","X58.XXXA","R07.81","E83.42","E83.52","M25.552","C80.1","C79.9","I08.1","K42.9","Z90.710","I77.1"],"date":["2021-08-24","2021-08-24","2021-08-24","2020-07-02","2020-01-16","2021-02-01","2020-01-16","2021-09-06","2021-08-28","2021-08-24","2021-09-06","2021-08-24","2021-08-31","2020-03-04","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2021-02-01","2021-08-28","2021-07-19","2021-09-06","2020-03-16","2021-08-24","2020-06-21","2021-08-24","2020-01-17","2021-05-27","2020-03-16","2020-03-16","2020-03-16","2021-08-31","2020-03-16","2021-06-26","2020-12-03","2021-06-27","2020-03-03","2020-03-02","2021-05-26","2020-03-02","2020-03-02","2020-03-16","2020-03-02","2020-03-02","2020-03-16","2021-07-20","2020-03-09","2021-08-24","2021-09-06","2021-05-26","2021-09-06","2021-08-28","2021-02-01","2020-06-21","2021-02-02","2021-08-28","2020-06-21","2021-07-20","2020-09-23","2021-03-30","2021-04-13","2020-07-02","2020-11-19","2020-11-19","2020-07-08","2021-08-28","2020-09-08","2020-09-10","2021-08-24","2021-08-31","2020-11-18","2021-07-19","2021-03-29","2020-11-18","2020-11-18","2020-11-19","2020-11-19","2020-12-15","2020-12-15","2021-01-11","2021-02-02","2021-02-01","2021-08-28","2021-03-10","2021-03-10","2021-03-10","2021-09-06","2021-03-29","2021-03-29","2021-08-24","2021-04-13","2021-05-26","2021-09-06","2021-05-26","2021-03-29","2021-08-24","2021-08-24","2021-08-24","2021-08-28","2021-05-26","2021-09-06","2021-07-07","2021-05-26","2021-05-26","2021-05-26","2021-05-27","2021-05-27","2021-05-27","2021-06-27","2021-09-06","2021-06-07","2021-06-08","2021-07-22","2021-08-24","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-08-28","2021-08-13","2021-06-25","2021-06-25","2021-07-21","2021-07-15","2021-06-25","2021-06-25","2021-07-30","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-09-07","2021-09-07","2021-09-06","2021-09-06","2021-09-07","2021-09-06","2021-09-06","2021-09-06","2021-09-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","60505294509","EZETIMIBE","TAB 10MG","","Select","Select",""],["","59762005001","METHYLPRED","TAB 16MG","","Select","Select",""],["","378827052","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","173069700","ADVAIR DISKU","AER 500\/50","","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","","Select","Select",""],["","597010061","SPIRIVA","SPR 2.5MCG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","93221001","SUCRALFATE","TAB 1GM","","Select","Select",""],["","591565810","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","378180910","LEVOTHYROXIN","TAB 100MCG","","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","68308015260","NYSTATIN","POW 100000","","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","","Select","Select",""],["","378041510","DIPHEN\/ATROP","TAB 2.5MG","","Select","Select",""],["","68382065005","ISOSORB MONO","TAB 30MG ER","","Select","Select",""],["","0","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","378967130","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","60505294509","EZETIMIBE ","TAB 10MG","90","Select","Select",""],["","173069700","ADVAIR ","AER 500\/50","180","Select","Select",""],["","59762005001","METHYLPRED ","TAB 16MG","12","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","378827052","ALBUTEROL ","NEB 0.00083","900","Select","Select",""],["","597010061","SPIRIVA ","SPR 2.5MCG","12","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","90","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","591565810","CYCLOBENZAPR ","TAB 10MG","63","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","93221001","SUCRALFATE ","TAB 1GM","360","Select","Select",""],["","378180910","LEVOTHYROXIN ","TAB 100MCG","90","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","36","Select","Select",""],["","68308015260","NYSTATIN ","POW 100000","60","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","0","LIDOCAINE ","SOL 2% VISC","300","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","378967130","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","31722070090","LOSARTAN ","25MG","90","Select","Select",""],["","378041510","DIPHEN\/ATROP ","2.5MG","100","Select","Select",""],["","54001925","PREDNISONE ","50MG","3","Select","Select",""],["","00173069700","ADVAIR","500\/50","180","Select","Select",""],["","16729020201","BUSPIRONE","10MG","60","Select","Select",""],["","57664050658","METOPROL","25MG","90","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","40","Select","Select",""],["","31722070090","LOSARTAN","25MG","90","Select","Select",""],["","68382065005","ISOSORB","30MG ER","30","Select","Select",""],["","68180065208","DOXYCYC","100MG","20","Select","Select",""],["","24658031205","DOXYCYCL","100MG","20","Select","Select",""],["","00054001925","PREDNISONE","50MG","3","Select","Select",""],["","68462010530","ONDANSETRON","4MG","20","Select","Select",""],["","13107008405","LORAZEPAM","1MG","10","Select","Select",""],["","00054051744","MORPHINE","100\/5ML","30","Select","Select",""],["","33342032980","TRIAMCINOLON","0.10%","80","Select","Select",""],["","71930005552","APAP\/CODEINE","300-30MG","12","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","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}