{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARGARET   A STRICKLAND","gend":1,"add":"6177 EDWARD ST APT 303","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1964-10-07","age":"","mstatus":"","insh":"900034333*01","cliId":"9YG8CM6FD26","pno":"302\/407-2451","cno":"302\/407-2451","email":"","ename":"","eno":"","pphy":"PAVON, HUMBERTO F MD","ppno":"757\/502-4840","pcpadd":"SUITE 101 5700 LAKE WRIGHT DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":141130,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/502-4841","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I70.209","E78.5","D53.9","I65.23","Z85.3","R94.31","Z79.899","I10.","M25.561","M89.8X9","G89.4","Z12.11","R55.","I73.9","R11.2","R00.2","Z86.61","Z87.891","Z79.82","Z88.0","Z88.5","R06.00","N65.0","C50.912","R07.9","R73.01","E78.00","R94.8","R73.9","G62.0","M79.606","M79.2","F33.2","F41.0","F43.12","F33.1","R70.0","M17.0","M81.8","J06.9","R05.","F31.32","F41.1","M25.552","G47.33","M46.1","F11.20","F33.9","R73.02","E55.9","I25.10","Z12.2","Z72.0","H04.122","R79.89","Z79.891","R30.0","Z98.82","F17.211","R93.89","E66.9","Z68.30","R07.81","R07.89","Z68.29","Z88.1","Z91.040","Z91.048","L65.9","R53.83","M25.562","S00.91XA","E53.9","G60.9","H90.42","H91.8X2","N65.1","M94.0","Z00.00","I77.6","M25.569","Z17.0","R42.","H53.8","B97.89","Z90.13","Z92.21","M79.604","M79.605","H52.03","R10.2","Z78.0","Z23.","S00.81XA","R00.0","Z51.81","M70.62","T78.40XA","R60.0","I66.8","G93.89","T07.XXXA","M54.5","R10.32","E03.9","N30.01","Z92.89","R04.0","G89.29","Z95.820","Z98.890","Z82.49","R06.83","G47.19","Z91.89","Z13.29","R53.81","Z87.19","E88.81","L65.0","Z71.9","L30.9","R91.8","N26.1","N28.1","I70.90","Z95.828","M54.6","K55.1","I70.8","R06.02","F41.9","Z68.31","R10.84","N30.00","H81.13","R05.9"],"date":["2020-07-30","2021-08-22","2020-07-30","2021-09-17","2021-10-11","2018-02-22","2021-09-01","2021-10-11","2019-06-12","2019-08-12","2018-03-29","2021-09-03","2019-08-27","2021-10-11","2021-10-11","2018-05-29","2018-04-30","2021-10-11","2018-04-30","2021-10-11","2021-10-11","2018-05-24","2018-05-29","2020-05-13","2021-10-11","2020-07-30","2019-08-12","2019-08-12","2019-09-24","2021-09-01","2021-09-01","2021-09-01","2021-04-08","2021-04-09","2021-04-19","2021-04-19","2018-04-06","2020-07-30","2020-05-12","2021-10-11","2019-02-07","2020-03-20","2021-04-19","2020-01-21","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-03-04","2021-04-08","2020-08-20","2020-08-20","2020-08-20","2020-10-30","2021-08-22","2020-02-02","2021-09-24","2018-07-03","2018-07-03","2019-09-24","2021-08-22","2018-11-09","2019-06-11","2021-08-22","2019-07-26","2021-10-11","2021-10-11","2020-02-02","2021-09-03","2020-09-09","2019-06-12","2018-03-28","2020-05-12","2018-10-11","2018-11-01","2018-11-01","2019-10-09","2019-10-09","2021-04-08","2020-07-30","2018-02-11","2020-05-12","2019-03-22","2019-09-24","2019-04-05","2020-02-02","2019-06-12","2019-09-24","2019-09-24","2019-10-15","2021-03-11","2021-03-11","2018-02-22","2018-03-28","2018-05-15","2020-09-16","2020-03-05","2018-07-06","2018-07-06","2019-08-27","2019-08-27","2020-01-17","2020-02-02","2021-09-24","2020-07-30","2020-10-30","2018-08-09","2019-07-15","2020-02-02","2021-08-22","2020-02-02","2021-08-22","2020-09-02","2020-09-02","2020-09-02","2021-04-08","2021-08-12","2021-08-12","2021-06-20","2021-10-14","2021-10-14","2021-09-03","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-10-11","2021-10-11","2021-10-11"],"priorHcc":["",null,"",null,null,"",null,null,"","","",null,"",null,null,"","",null,"",null,null,"","","",null,"","","","",null,null,null,"","","","","","","",null,"","","","","","","","","","","","","","",null,"",null,"","","",null,"","",null,"",null,null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","",null,"",null,"","","","","","","",null,null,null,null,null,null,null,null,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":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","10702001801","OXYCODONE","TAB 5MG","120","Select","Select",""],["","70377000415","SIMVASTATIN","TAB 40MG","-90","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","120","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","63402030830","LATUDA","TAB 80MG","30","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","0","COMPOUND"," ","100","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","50","Select","Select",""],["","16729003415","LETROZOLE","TAB 2.5MG","90","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","-60","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","93720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","228202950","ALPRAZOLAM","TAB 0.5MG","7","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","40","Select","Select",""],["","49884072501","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","70954001910","PRAZOSIN HCL","CAP 1MG","30","Select","Select",""],["","43547030203","ARIPIPRAZOLE","TAB 2MG","14","Select","Select",""],["","378247401","DICLOFEN POT","TAB 50MG","20","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","27808008602","HYD POL\/CPM","SUS 10-8\/5ML","118","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","591565810","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","68180021509","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","","30","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","","90","Select","Select",""],["","63304069205","CLINDAMYCIN HYDROCHLORIDE ","","28","Select","Select",""],["","93317431","ALBUTEROL SULFATE HFA","","8","Select","Select",""],["","65862032904","ALENDRONATE SODIUM ","","12","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN","","120","Select","Select",""],["","13668000705","ZOLPIDEM TARTRATE","","30","Select","Select",""],["","16729003415","LETROZOLE ","","-90","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","0","","","100","Select","Select",""],["","27808008602","HYDROCODONE POLISTIREX\/CHLORPHENIRAMINE POLISTIREX","","118","Select","Select",""],["","60505384901","CELECOXIB ","","50","Select","Select",""],["","591565810","CYCLOBENZAPRINE HYDROCHLORIDE","","20","Select","Select",""],["","49884072501","BUSPIRONE HYDROCHLORIDE","","60","Select","Select",""],["","70954001910","PRAZOSIN HYDROCHLORIDE","","30","Select","Select",""],["","93720198","PRAVASTATIN SODIUM ","","90","Select","Select",""],["","14539067501","HYDROXYZINE PAMOATE","","30","Select","Select",""],["","378247401","DICLOFENAC POTASSIUM ","","20","Select","Select",""],["","13668013601","ESCITALOPRAM OXALATE ","","14","Select","Select",""],["","65162074510","PROMETHAZINE HCL","","40","Select","Select",""],["","10702001801","OXYCODONE HYDROCHLORIDE","","120","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","","100","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","","14","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM ","","90","Select","Select",""],["","63304069301","CLINDAMYCIN HCL ","","21","Select","Select",""],["","63304069205","CLINDAMYCIN HYDROCHLORIDE","","28","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM","","90","Select","Select",""],["","65862032904","ALENDRONATE SODIUM","","12","Select","Select",""],["","00378247401","DICLOFENAC POTASSIUM","","20","Select","Select",""],["","13668013601","ESCITALOPRAM OXALATE","","14","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM","","90","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","","21","Select","Select",""],["","59267100003","PFIZER-BIONTECH COVID-19 VACCINE","COVID-19","0","Select","Select",""],["","59779030501","CVS CLOTRIMAZOLE","0.01","14","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE","500MG","10","Select","Select",""],["","68462018117","CLOTRIMAZOLE","0.01","15","Select","Select",""],["","00143122701","DICYCLOMINE HYDROCHLORIDE","20MG","120","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE                                                   ","TAB 10MG","90","Select","Select",""],["","49884072501","BUSPIRONE HYDROCHLORIDE                                               ","TAB 7.5MG","60","Select","Select",""],["","00228202950","ALPRAZOLAM                                                            ","TAB 0.5MG","7","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 5-325MG","120","Select","Select",""],["","00378247401","DICLOFENAC POTASSIUM                                                  ","TAB 50MG","20","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM                                                    ","TAB 20MG","90","Select","Select",""],["","13668013701","ESCITALOPRAM OXALATE                                                  ","TAB 20MG","30","Select","Select",""],["","16729003415","LETROZOLE                                                             ","TAB 2.5MG","90","Select","Select",""],["","65862085901","FAMOTIDINE                                                            ","TAB 20MG","60","Select","Select",""],["","10702001801","OXYCODONE HYDROCHLORIDE                                               ","TAB 5MG","-120","Select","Select",""],["","00591565810","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 10MG","20","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","GEL 0.01","100","Select","Select",""],["","68180016013","AZITHROMYCIN                                                          ","TAB 250MG","6","Select","Select",""],["","70954001910","PRAZOSIN HYDROCHLORIDE                                                ","CAP 1MG","30","Select","Select",""],["","43547030203","ARIPIPRAZOLE                                                          ","TAB 2MG","14","Select","Select",""],["","65162074510","PROMETHAZINE HCL                                                      ","TAB 12.5MG","40","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","CAP 100MG","14","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA                                                 ","AER HFA","7","Select","Select",""],["","63304069301","CLINDAMYCIN HCL                                                       ","CAP 300MG","21","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM                                                    ","TAB 50MG","90","Select","Select",""],["","00143122701","DICYCLOMINE HYDROCHLORIDE                                             ","TAB 20MG","120","Select","Select",""],["","59267100003","PFIZER-BIONTECH COVID-19 VACCINE                                      ","INJ COVID-19","0","Select","Select",""],["","59779030501","CVS CLOTRIMAZOLE                                                      ","CRE 0.01","14","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","10","Select","Select",""],["","68462018117","CLOTRIMAZOLE                                                          ","CRE 0.01","15","Select","Select",""],["","81421002204","DULCOLAX STOOL SOFTENER                                               ","CAP 100MG","4","Select","Select",""],["","69097015807","MELOXICAM                                                             ","TAB 7.5MG","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","TAB 800-160","14","Select","Select",""],["","16571066101","MECLIZINE HYDROCHLORIDE                                               ","TAB 25MG","30","Select","Select",""],["","59746012106","MECLIZINE HCL                                                         ","TAB 25MG","-30","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL 3350                                              ","POW 3350 NF","238","Select","Select",""],["","57237007710","ONDANSETRON ODT                                                       ","TAB 4MG ODT","10","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":""}]}]}