{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN   E DWYER","gend":1,"add":"10290 BROOK ROAD APT A115","city":"GLEN ALLEN","state":"VA","zip":"23059-9998","dob":"1953-04-08","age":"","mstatus":"","insh":"900034391*01","cliId":"1XF7YX1PM52","pno":"757\/817-9708","cno":"757\/817-9708","email":"","ename":"","eno":"","pphy":"BLACKBURN, MAURICE LEE MD","ppno":"804\/730-0990","pcpadd":"9376 ATLEE STATION ROAD","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23116,"pcpcounty":"","pcpid":203014,"pcpname":"VPI - Hanover Family Physicians","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"757\/817-9708","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/730-8752","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.5","G47.33","I10.","F41.1","F32.4","E03.9","E78.00","R73.01","H25.813","Z00.00","G47.30","R73.03","Z23.","R35.0","N13.2","N28.1","N20.0","N17.9","Z01.818","E66.9","R15.0","R94.31","Z86.010","Z20.828","R31.21","N20.1","K21.9","H25.13","M79.7","Z91.81","Z96.652","E66.3","F33.0","F90.0","G47.00","Z13.29","Z12.11","Z78.0","Z12.39","Z01.812","N30.00","R30.0","K63.5","R35.1","R19.4","N81.10","N39.0","Z87.442","D12.5","H25.12","H26.9"],"date":["2020-12-15","2021-05-24","2021-10-06","2021-04-05","2021-04-05","2021-10-06","2021-10-06","2021-04-05","2020-09-30","2021-07-06","2021-07-06","2021-10-06","2021-10-06","2021-10-06","2021-11-03","2021-11-03","2021-11-04","2020-01-02","2020-09-21","2020-09-28","2020-09-28","2020-09-21","2020-09-28","2020-10-01","2021-11-04","2021-11-04","2020-01-03","2020-07-07","2020-12-15","2020-08-05","2020-08-05","2020-08-18","2020-12-15","2020-12-15","2020-12-15","2020-05-28","2020-09-24","2020-06-04","2020-06-04","2020-10-01","2021-05-27","2021-05-27","2020-09-24","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2020-09-24","2020-10-07","2020-10-07"],"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,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":[["","68180012202","CEPHALEXIN","500MG","6","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","68382003516","","75MG ER","270","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","270","Select","Select",""],["","76385011150","CARVEDILOL","6.25MG","180","Select","Select",""],["","00603233832","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","13668000705","ZOLPIDEM","5MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","4","Select","Select",""],["","10702010001","METHYLPHENID","5MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","00378180310","LEVOTHYROXIN","50MCG","90","Select","Select",""],["","24208044605","BESIVANCE","0.60%","5","Select","Select",""],["","00065175014","ILEVRO","0.3% OP","3","Select","Select",""],["","24208050307","LOTEMAX","0.50%","5","Select","Select",""],["","00093117410","PENICILLN","500MG","40","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","13668018930","TOLTERODINE","2MG ER","-30","Select","Select",""],["","70010049110","METFORMIN","500MG ER","90","Select","Select",""],["","70461012003","FLUAD","0.5ML","0","Select","Select",""],["","68462046160","TROSPIUM","20MG","180","Select","Select",""],["","13668000705","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","270","Select","Select",""],["","76385011150","CARVEDILOL ","TAB 6.25MG","180","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","6","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","4","Select","Select",""],["","00603233832","APAP\/CODEINE ","TAB 300-30MG","12","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","90","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","40","Select","Select",""],["","10702010001","METHYLPHENID ","TAB 5MG","30","Select","Select",""],["","24208044605","BESIVANCE ","SUS 0.006","5","Select","Select",""],["","24208050307","LOTEMAX ","GEL 0.005","5","Select","Select",""],["","00065175007","ILEVRO ","DRO 0.3% OP","2","Select","Select",""],["","13668018930","TOLTERODINE ","CAP 2MG ER","30","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0","Select","Select",""],["","70010049110","METFORMIN ","TAB 500MG ER","-90","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","Select","Select",""],["","68462046160","TROSPIUM ","TAB 20MG","180","Select","Select",""],["","42858030101","HYDROMORPHON ","TAB 2MG","20","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","",""],["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":""}]}]}