{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AVIS   T SUTTON","gend":1,"add":"1213 WARFIELD DR","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1952-04-18","age":"","mstatus":"","insh":"900035535*01","cliId":"9DH2YV3NP86","pno":"757\/487-7056","cno":"757\/487-7056","email":"","ename":"","eno":"","pphy":"DONALDSON, NICOLE MD","ppno":"757\/227-6866","pcpadd":"SUITE 504 301 RIVERVIEW AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161071,"pcpname":"Fort Norfolk Plaza Primary Care","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/277-0298","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.3293","H35.033","E11.9","E11.40","I10.","E78.5","E03.9","J06.9","M85.80","C50.412","R32.","R15.9","I50.40","M00.9","R07.81","R94.8","Z85.3","J18.9","R07.89","R10.9","K63.3","K63.89","K92.2","I50.20","G47.33","G47.00","Z72.821","Z99.89","N60.32","N61.0","N63.0","J42.","J47.9","I31.3","R07.9","C50.912","Z17.0","D64.9","D50.8","K52.9","Z68.38","D72.829","I50.9","K28.9","R11.0","M20.11","M72.2","Z12.31","Z78.0","M81.0","N63.25","N60.02","N64.4","N63.10","R92.8","Z68.34","E66.9","L68.0","I11.0","J45.909","E70.0","N63.21","N64.89","N18.9","D63.1","E66.01","Z12.11","R76.8","Z79.811","M25.561","M54.5","M25.552","Z08.","Z78.9","M85.9","H40.013","K52.89","R11.2","M79.671","R00.2","R42.","K92.0","I50.32","Z68.37","K28.4","Z20.822","M19.90","E86.9","Z90.710","Z90.10","Z87.891","Z98.84","E53.8","Z68.39","M48.061","M51.16","H40.9","M10.9","D50.9","K59.00","E66.3","R05.","G54.2","M25.511","M25.512","R25.1","M17.11","M54.41","M54.2","M25.50","M47.812","M47.816","M43.16","M54.40","M17.12","M25.562","M25.662","M54.9","M54.16","L25.9"],"date":["2021-04-20","2021-04-20","2020-12-01","2021-03-28","2021-10-12","2021-02-14","2021-03-28","2020-01-15","2021-11-09","2021-07-21","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-12-15","2020-12-15","2021-11-09","2021-02-18","2021-02-14","2021-02-14","2021-02-16","2021-02-18","2021-02-17","2021-03-09","2021-10-12","2019-09-27","2021-10-12","2021-10-12","2020-06-03","2020-06-03","2020-06-03","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-10-14","2021-07-21","2021-07-21","2021-07-21","2021-02-16","2021-02-15","2021-02-19","2021-10-12","2021-04-13","2021-02-18","2019-09-30","2019-09-30","2021-05-11","2021-11-09","2019-10-07","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-06-03","2020-06-03","2021-03-28","2020-07-16","2021-03-28","2021-03-28","2019-07-19","2020-05-07","2020-05-07","2021-07-21","2021-07-21","2021-10-12","2021-05-23","2021-01-14","2021-07-21","2021-07-06","2020-05-14","2020-05-14","2021-07-21","2021-02-02","2019-10-31","2019-11-22","2021-03-16","2021-03-16","2019-07-10","2020-01-15","2020-01-15","2021-02-14","2021-03-28","2021-02-19","2021-02-14","2021-02-14","2021-03-28","2021-02-14","2021-02-14","2021-02-14","2021-07-21","2021-02-16","2021-03-28","2021-03-28","2021-03-28","2021-03-28","2021-03-28","2021-03-28","2021-07-21","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-09-24","2021-09-24","2021-09-24","2021-07-06","2021-07-06","2021-07-06"],"priorHcc":["","","","",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":[["","67877022310","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","59651018030","LETROZOLE","TAB 2.5MG","90","Select","Select",""],["","832532511","POT CL MICRO","TAB 20MEQ ER","-90","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","68682010510","NIFEDIPINE","TAB 30MG ER","-90","Select","Select",""],["","69452014320","BENZONATATE","CAP 100MG","30","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","65702010210","ACCU-CHEK","MIS AVIVA","-1","Select","Select",""],["","781518092","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","72305002530","EUTHYROX","TAB 25MCG","90","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","63739019861","PEG 3350","POW ","15","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","100","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","30","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","168000480","TRIAMCINOLON","CRE 0.001","-160","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","69784018010","POLYETH GLYC","POW 3350 NF","15","Select","Select",""],["","62332014231","CELECOXIB","CAP 200MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","143928501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","68645048154","ATORVASTATIN CALCIUM ","","-90","Select","Select",""],["","68682010510","NIFEDIPINE ER ","","90","Select","Select",""],["","62332014231","CELECOXIB ","","60","Select","Select",""],["","781518092","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","68682010301","DICLOFENAC SODIUM ER ","","30","Select","Select",""],["","93762056","LETROZOLE ","","90","Select","Select",""],["","65702040710","ACCU-CHEK AVIVA PLUS ","","50","Select","Select",""],["","832532511","POTASSIUM CHLORIDE ER","","90","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","","100","Select","Select",""],["","65702010210","ACCU-CHEK AVIVA ","","-1","Select","Select",""],["","65702015610","ACCU-CHEK SOFTCLIX LANCETS","","100","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","","20","Select","Select",""],["","57237001830","DULOXETINE HYDROCHLORIDE","","30","Select","Select",""],["","45802006436","TRIAMCINOLONE ACETONIDE","","160","Select","Select",""],["","69784018010","POLYETHYLENE GLYCOL 3350","","15","Select","Select",""],["","59267100002","PFIZER-BIONTECH COVID-19 VACCINE","","0","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","","60","Select","Select",""],["","68645056354","IBUPROFEN ","","20","Select","Select",""],["","68682010301","DICLOFENAC SODIUM ER","","30","Select","Select",""],["","68682010510","NIFEDIPINE ER","","-90","Select","Select",""],["","68645048154","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","00781518092","LEVOTHYROXINE SODIUM","","-90","Select","Select",""],["","65702010210","ACCU-CHEK AVIVA","","1","Select","Select",""],["","65702072310","ACCU-CHEK AVIVA PLUS","","1","Select","Select",""],["","59651018030","LETROZOLE                                                             ","TAB 2.5MG","-90","Select","Select",""],["","68682010510","NIFEDIPINE ER                                                         ","TAB 30MG ER","90","Select","Select",""],["","65702040710","ACCU-CHEK AVIVA PLUS                                                  ","TES AVIVA PL","50","Select","Select",""],["","65702010210","ACCU-CHEK AVIVA                                                       ","MIS AVIVA","-1","Select","Select",""],["","65702015610","ACCU-CHEK SOFTCLIX LANCETS                                            ","MIS LANCETS","100","Select","Select",""],["","68645048154","ATORVASTATIN CALCIUM                                                  ","TAB 20MG","90","Select","Select",""],["","68645055354","LISINOPRIL                                                            ","TAB 20MG","90","Select","Select",""],["","69452014320","BENZONATATE                                                           ","CAP 100MG","30","Select","Select",""],["","00832532511","POTASSIUM CHLORIDE ER                                                 ","TAB 20MEQ ER","90","Select","Select",""],["","00781518092","LEVOTHYROXINE SODIUM                                                  ","TAB 25MCG","-90","Select","Select",""],["","68382009505","CARVEDILOL                                                            ","TAB 25MG","180","Select","Select",""],["","57237001830","DULOXETINE HYDROCHLORIDE                                              ","CAP 30MG","30","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE                                               ","CRE 0.001","120","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE                                                   ","TAB 100MG","20","Select","Select",""],["","72305002530","EUTHYROX                                                              ","TAB 25MCG","-90","Select","Select",""],["","67877022310","GABAPENTIN                                                            ","CAP 300MG","270","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","GEL 0.01","100","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","90","Select","Select",""],["","69784018010","POLYETHYLENE GLYCOL 3350                                              ","POW 3350 NF","15","Select","Select",""],["","63739019861","PEG 3350                                                              ","POW ","15","Select","Select",""],["","00143928501","AMOXICILLIN                                                           ","TAB 875MG","14","Select","Select",""],["","59267100002","PFIZER-BIONTECH COVID-19 VACCINE                                      ","INJ COVID-19","0","Select","Select",""],["","68645056354","IBUPROFEN                                                             ","TAB 800MG","-20","Select","Select",""],["","63304069301","CLINDAMYCIN HCL                                                       ","CAP 300MG","-14","Select","Select",""],["","00406048410","ACETAMINOPHEN\/CODEINE                                                 ","TAB 300-30MG","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":[[["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":""}]}]}