{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA   K MILES","gend":1,"add":"19278 BEAVERDAM RD","city":"BEAVERDAM","state":"VA","zip":"23015-9998","dob":"1959-08-07","age":"","mstatus":"","insh":"900034966*01","cliId":"4GW4WU2PV72","pno":"804\/449-1479","cno":"804\/449-1479","email":"","ename":"","eno":"","pphy":"ESSAH, PAULINA A MD","ppno":"804\/798-9208","pcpadd":"STE C 306 ASHCAKE RD","pcpcity":"ASHLAND","pcpstate":"VA","pcpzip":23005,"pcpcounty":"","pcpid":208016,"pcpname":"BON SECOURS INTERNAL MEDICINE OF ASHLAND","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"804\/877-2852","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/798-8108","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F41.9","G47.00","Z68.33","I10.","J45.909","J45.998","R06.83","J30.9","K21.9","Z91.09","F31.12","Z12.31","Z68.34","I51.7","I95.9","R00.0","R07.9","R06.09","Z96.651","E03.9","R39.15","Z79.890","Z96.653","M17.0","I73.9","Z68.36","R06.00","N18.1","I95.2","R00.2","Z71.9","J98.4","M85.851","R05.","M41.84","M47.814","K80.20","M81.0","R93.5","N28.1","J45.20","Z87.39","Z68.35","N39.0","C73.","Z76.89","R73.03","R53.83","R42.","R73.09","G47.10","Z92.29","F31.4","R10.11","M54.6","R07.1","Z87.19","K76.0","Z12.4","Z01.419","Z11.51","Z00.00","E78.2","M89.9","R31.9","Z11.59","G25.81","Z71.3","R35.0","F31.77","F06.4","F41.0","H90.3","M17.11","Z20.828","E89.0","C75.9","R60.9","J06.9","Z79.82","R09.81","N30.01","R53.82","N20.0","D22.9","Z23.","Z12.11","N18.2","E55.9","I12.9","Z13.1","G47.33","R80.9","Z13.820","M85.80","Z78.0","R07.89","M54.31","R10.84","K59.00","Z98.890","R10.9","J98.11","L25.5","K80.10","I25.10","Z87.442","G51.0","Z85.850","Z79.899","Z79.51","R06.89","K80.11","F31.81","R10.13","R19.5","J40.","E66.9","Z90.49","E66.01"],"date":["2019-11-12","2021-10-11","2019-10-29","2018-12-05","2021-08-30","2021-11-11","2019-01-11","2019-05-16","2021-11-11","2021-07-13","2021-11-11","2019-09-16","2021-04-13","2021-08-16","2019-07-05","2019-11-12","2020-10-19","2021-05-14","2021-05-04","2020-11-09","2021-08-16","2019-11-05","2019-11-05","2019-11-06","2019-11-06","2021-03-02","2021-01-25","2021-07-21","2021-08-30","2020-10-19","2020-10-19","2021-11-11","2021-05-07","2021-03-08","2019-02-09","2019-06-26","2019-06-26","2021-08-16","2021-09-09","2019-06-26","2021-05-19","2019-07-15","2021-03-08","2021-03-02","2019-12-20","2021-09-09","2020-10-02","2021-08-16","2019-06-19","2019-11-12","2018-12-18","2019-02-07","2019-06-06","2019-04-12","2021-07-17","2019-06-26","2019-06-19","2019-06-19","2021-08-06","2021-01-27","2019-09-19","2019-09-19","2021-01-25","2021-08-16","2019-12-20","2019-12-20","2019-12-20","2019-03-27","2019-03-27","2019-11-05","2021-03-02","2021-08-16","2021-08-16","2020-06-18","2020-11-09","2020-12-28","2021-02-26","2021-02-26","2018-12-07","2019-02-09","2019-02-09","2019-02-09","2019-11-12","2019-11-12","2021-05-19","2019-11-12","2019-12-20","2021-08-16","2021-08-17","2021-08-30","2021-08-30","2021-02-03","2019-03-21","2019-08-02","2021-03-08","2021-03-08","2021-03-08","2021-05-14","2021-05-14","2021-07-17","2021-07-17","2021-07-17","2021-07-17","2021-05-04","2021-07-09","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-07-21","2021-08-06","2021-10-11","2021-07-17","2021-10-20","2021-11-11","2021-11-11","2021-11-11","2021-08-16"],"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]}},{"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":[["","69584009250","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","68001041306","DULOXETINE","CAP 20MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","69238183501","LEVOTHYROXIN","TAB 112MCG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","37024523","DYMISTA","SPR 137-50","23","Select","Select",""],["","173088210","BREO ELLIPTA","INH 200-25","60","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","90","Select","Select",""],["","67877019790","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","70461032003","FLUCLVX QUAD","INJ 2020-21","0","Select","Select",""],["","60505095303","AZEL\/FLUTIC","SPR 137-50","23","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","-1","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","62332003131","ROPINIROLE","TAB 0.5MG","120","Select","Select",""],["","781531710","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","69238134201","ETODOLAC","TAB 400MG","60","Select","Select",""],["","65862054890","VALSART\/HCTZ","TAB 160-12.5","90","Select","Select",""],["","59746036190","VALSARTAN","TAB 80MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","93317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","68382024701","BENZONATATE","CAP 100MG","30","Select","Select",""],["","16729011917","MONTELUKAST SODIUM ","","30","Select","Select",""],["","64380074207","BUSPIRONE HCL ","","90","Select","Select",""],["","59746036190","VALSARTAN ","","90","Select","Select",""],["","781531710","ZOLPIDEM TARTRATE","","30","Select","Select",""],["","37024523","DYMISTA ","","23","Select","Select",""],["","64380074206","BUSPIRONE HYDROCHLORIDE","","90","Select","Select",""],["","67877019790","AMLODIPINE BESYLATE","","90","Select","Select",""],["","527134601","LEVOTHYROXINE SODIUM ","","30","Select","Select",""],["","65862054890","VALSARTAN\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","62332003131","ROPINIROLE HCL","","120","Select","Select",""],["","60505095303","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE","","-23","Select","Select",""],["","70461031903","FLUCELVAX QUADRIVALENT 2019-2020","","0","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","70461032003","FLUCELVAX QUADRIVALENT 2020-2021","","0","Select","Select",""],["","68001041306","DULOXETINE HYDROCHLORIDE","","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","43547039910","CYCLOBENZAPRINE HYDROCHLORIDE","","21","Select","Select",""],["","64380074206","BUSPIRONE HCL","","90","Select","Select",""],["","16729011917","MONTELUKAST SODIUM","","30","Select","Select",""],["","69238183501","LEVOTHYROXINE SODIUM","","30","Select","Select",""],["","68001000501","METHYLPREDNISOLONE DOSE PACK","4MG","21","Select","Select",""],["","45802006405","TRIAMCINOLONE ACETONIDE","0.10%","15","Select","Select",""],["","65862039010","ONDANSETRON ODT","4MG ODT","10","Select","Select",""],["","43199001101","HYOSCYAMINE SULFATE","0.125MG","10","Select","Select",""],["","00406012310","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","5-325MG","-12","Select","Select",""],["","67877019790","AMLODIPINE BESYLATE                                                   ","TAB 2.5MG","90","Select","Select",""],["","16729020201","BUSPIRONE HYDROCHLORIDE                                               ","TAB 10MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE                                                           ","TAB 25MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE                                                            ","CAP 40MG","30","Select","Select",""],["","69238183501","LEVOTHYROXINE SODIUM                                                  ","TAB 112MCG","30","Select","Select",""],["","16729011917","MONTELUKAST SODIUM                                                    ","TAB 10MG","30","Select","Select",""],["","00173088210","BREO ELLIPTA                                                          ","INH 200-25","60","Select","Select",""],["","60505095303","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE                       ","SPR 137-50","-23","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","1","Select","Select",""],["","00037024523","DYMISTA                                                               ","SPR 137-50","23","Select","Select",""],["","70461032003","FLUCELVAX QUADRIVALENT 2020-2021                                      ","INJ 2020-21","0","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","AER ","8","Select","Select",""],["","00781531710","ZOLPIDEM TARTRATE                                                     ","TAB 5MG","30","Select","Select",""],["","65862001501","AMOXICILLIN                                                           ","TAB 875MG","20","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","68001041306","DULOXETINE HYDROCHLORIDE                                              ","CAP 20MG","30","Select","Select",""],["","43547039910","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 5MG","21","Select","Select",""],["","65862039010","ONDANSETRON ODT                                                       ","TAB 4MG ODT","10","Select","Select",""],["","43199001101","HYOSCYAMINE SULFATE                                                   ","SUB 0.125MG","10","Select","Select",""],["","68001000501","METHYLPREDNISOLONE DOSE PACK                                          ","TAB 4MG","21","Select","Select",""],["","45802006405","TRIAMCINOLONE ACETONIDE                                               ","CRE 0.001","15","Select","Select",""],["","00781552810","BUPROPION HYDROCHLORIDE ER (XL)                                       ","TAB 150MG XL","30","Select","Select",""],["","00406012305","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","30","Select","Select",""],["","10572010001","PEG-3350\/ELECTROLYTES                                                 ","SOL ELECTROL","-4000","Select","Select",""],["","52268010001","GOLYTELY                                                              ","SOL ","4000","Select","Select",""],["","70461032103","FLUCELVAX QUADRIVALENT 2021-2022                                      ","INJ 2021-22","0","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":""}]}]}