{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY HARRIS","gend":0,"add":"2519 BROAD ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1964-08-07","age":"","mstatus":"","insh":"900034964*01","cliId":"3J88TG4GQ38","pno":"757\/972-0431","cno":"757\/972-0431","email":"","ename":"","eno":"","pphy":"SHAH, DHARMESH K MD","ppno":"757\/543-6861","pcpadd":"710 LIBERTY STREET","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":122310,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/543-4082","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K56.1","K92.2","D69.6","D50.0","G89.29","K62.89","R06.00","J44.1","J80.","K62.3","K62.5","D50.9","D12.2","K62.9","I10.","J45.909","R06.02","F31.9","Z85.828","Z76.0","Z88.0","Z79.899","Z79.51","Z91.14","F17.200","Z00.00","R10.9","D12.8","C20.","R11.2","F10.99","Z71.1","R00.0","E55.9","F17.210","E86.0","G47.00","E78.5","J45.901","R42.","Z79.1","R06.2","J40.","D62.","K62.1","D72.829","K40.90","K76.9","J41.0","J44.9","E78.2"],"date":["2019-03-11","2019-03-11","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-10-06","2021-09-22","2021-10-06","2021-04-12","2019-03-07","2019-03-07","2019-03-08","2019-03-07","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2019-03-06","2019-03-08","2019-03-28","2019-03-11","2019-03-26","2019-01-12","2019-03-05","2021-09-02","2021-10-06","2019-01-12","2019-09-12","2019-09-12","2021-10-06","2019-01-09","2019-01-09","2019-01-09","2021-10-18","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2021-09-22","2021-09-02","2021-09-02"],"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":[]},{"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":[["","00173068220","VENTOLIN HFA","","36","Select","Select",""],["","59310057922","PROAIR HFA","","8","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","20","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","HFA","18","Select","Select",""],["","31722053401","METHOCARBAMOL","750MG","20","Select","Select",""],["","00310737220","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","80-4.5","10","Select","Select",""],["","10370083111","DILTIAZEM HYDROCHLORIDE ER","240MG ER","30","Select","Select",""],["","27808015501","ROSUVASTATIN CALCIUM","5MG","30","Select","Select",""],["","69452015120","VITAMIN D","50000UNT","5","Select","Select",""],["","00487950103","ALBUTEROL SULFATE","0.08%","90","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5MCG","4","Select","Select",""],["","13668033101","TRAZODONE HYDROCHLORIDE","100MG","30","Select","Select",""],["","00597008717","ATROVENT HFA","17MCG","13","Select","Select",""],["","00186037220","SYMBICORT                                                             ","AER 80-4.5","-20","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","36","Select","Select",""],["","31722053401","METHOCARBAMOL                                                         ","TAB 750MG","20","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","AER ","8","Select","Select",""],["","65862064163","AZITHROMYCIN                                                          ","TAB 250MG","6","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","18","Select","Select",""],["","13668033101","TRAZODONE HYDROCHLORIDE                                               ","TAB 100MG","30","Select","Select",""],["","00487030101","ALBUTEROL SULFATE                                                     ","NEB 0.63MG\/3","-30","Select","Select",""],["","60505001606","DILT-XR                                                               ","CAP 240MG","-30","Select","Select",""],["","00597008717","ATROVENT HFA                                                          ","AER 17MCG","-13","Select","Select",""],["","10370083109","DILTIAZEM HYDROCHLORIDE ER                                            ","CAP 240MG ER","30","Select","Select",""],["","00310737220","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE                              ","AER 80-4.5","10","Select","Select",""],["","27808015501","ROSUVASTATIN CALCIUM                                                  ","TAB 5MG","30","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","5","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT                                                      ","SPR 2.5MCG","4","Select","Select",""],["","65162046650","IBUPROFEN                                                             ","TAB 800MG","60","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":""}]}]}