{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DORA   R BOWMAN","gend":1,"add":"9600 LITTLE ELAM ROAD","city":"CHARLES CITY","state":"VA","zip":"23030-9998","dob":"1940-08-17","age":"","mstatus":"","insh":"900035683*01","cliId":"4G95Y61DH83","pno":"804\/829-2174","cno":"804\/829-2174","email":"","ename":"","eno":"","pphy":"GOKLI, ANUP J MD","ppno":"804\/932-4388","pcpadd":"1850 POCAHONTAS TRAIL","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":23141,"pcpcounty":"","pcpid":671676,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/932-9860","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","I73.9","L03.116","E11.9","D64.9","I10.","E11.59","E78.2","I11.0","Z01.818","Z68.35","Z79.899","B35.1","M79.674","M79.675","R42.","I13.0","I50.22","N18.32","E11.40","E11.21","E11.65","I70.245","L03.032","Z95.820","M62.81","R26.2","I47.2","R33.9","Z95.810","L97.522","E11.51","L20.89","I96.","I42.8","R00.0","T82.858A","I70.402","I48.0","Z79.4","Z68.39","E11.3293","H26.493","Z79.84","E53.9","E55.9","L84.","Z89.422","M79.672","Z68.38","E11.42","L85.1","M21.41","M21.42","I70.91","Z79.82","Z91.81","M86.9","L97.524","L08.9","M79.89","I70.445","A41.9","L03.90","E78.5","I11.9","N18.30","R94.4","L97.528","M85.872","M79.605","R53.1","M86.8X7","I25.2","I34.0","I49.9","I95.1","E66.01","I50.9","R53.81","R53.83","R06.02","J22.","E11.621","L97.529","E78.00","I51.89","I36.1","I27.0","R50.9","L53.9","Z23.","G62.9","I42.9","E11.22","N18.3","Z12.31","R07.9","K92.1","R60.1","R05.","I13.10","Z98.62","I48.91","E87.2","I25.10","M85.80","Z68.37","Z68.36","I12.9","D63.1","Z00.01","I05.8"],"date":["2019-10-01","2021-10-18","2019-11-12","2020-12-14","2019-08-12","2021-09-29","2021-10-18","2021-10-18","2021-10-18","2019-09-24","2019-10-01","2021-01-06","2021-08-02","2020-01-28","2020-01-28","2020-07-21","2021-04-08","2021-10-18","2021-01-06","2021-10-18","2021-01-06","2021-09-29","2019-07-31","2019-11-08","2019-09-01","2019-09-01","2019-09-01","2019-09-30","2019-09-19","2021-10-25","2019-08-21","2020-06-24","2019-09-10","2019-09-30","2021-10-25","2019-10-29","2021-01-12","2021-01-12","2021-10-18","2021-10-18","2019-09-04","2019-12-10","2020-12-14","2019-12-10","2019-12-23","2019-12-23","2020-06-24","2020-06-24","2020-06-24","2021-10-18","2021-08-02","2021-08-02","2021-01-04","2021-01-04","2019-08-11","2021-10-18","2019-09-19","2019-09-30","2019-09-30","2019-09-30","2019-10-31","2020-11-12","2019-11-02","2019-11-02","2019-11-02","2020-05-24","2021-07-14","2021-01-25","2019-08-09","2019-08-09","2019-10-31","2019-10-29","2019-09-30","2020-03-11","2019-09-30","2019-10-01","2019-10-01","2021-10-18","2021-10-25","2019-10-29","2020-01-30","2020-01-30","2020-02-06","2019-08-01","2019-08-01","2020-03-11","2019-08-04","2019-08-04","2019-08-04","2019-08-09","2019-10-30","2021-10-18","2020-10-01","2021-07-21","2021-10-18","2020-06-30","2020-11-02","2019-09-04","2019-09-04","2019-10-31","2020-02-06","2020-10-01","2021-01-12","2019-08-05","2019-10-30","2019-10-30","2019-10-30","2021-09-29","2020-03-11","2021-10-18","2021-07-14","2021-10-18","2021-09-20"],"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]}},{"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":[["","55111032101","GLIMEPIRIDE","TAB 2MG","90","Select","Select",""],["","378395005","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","54429931","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","5","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","180","Select","Select",""],["","8290320109","BD PEN NEEDL","MIS 31GX8MM","-200","Select","Select",""],["","68462016405","CARVEDILOL","TAB 12.5MG","-270","Select","Select",""],["","597015960","SYNJARDY","TAB 5-500MG","180","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","169406013","VICTOZA","INJ 18MG\/3ML","-9","Select","Select",""],["","24586903","TOUJEO SOLO","INJ 300IU\/ML","15","Select","Select",""],["","591544221","PREDNISONE","PAK 10MG","21","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","100","Select","Select",""],["","99073070805","FREESTYLE","MIS LITE","1","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","-1","Select","Select",""],["","8470113001","UNIFINE PNTP","MIS 31GX8MM","150","Select","Select",""],["","65862020299","LOSARTAN POT","TAB 50MG","180","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","1","Select","Select",""],["","93317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","2","Select","Select",""],["","406012305","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","51672130005","AMMONIUM LAC","LOT 0.12","225","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","-30","Select","Select",""],["","63304069301","CLINDAMYCIN HCL ","","28","Select","Select",""],["","24586903","TOUJEO SOLOSTAR ","","15","Select","Select",""],["","406012305","HYDROCODONE\/ACETAMINOPHEN ","","28","Select","Select",""],["","53489014305","SPIRONOLACTONE","","90","Select","Select",""],["","68180037703","LOSARTAN POTASSIUM ","","180","Select","Select",""],["","8290320109","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM","","100","Select","Select",""],["","93317431","ALBUTEROL SULFATE HFA","","8","Select","Select",""],["","378395077","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","60432060416","PROMETHAZINE\/DEXTROMETHORPHAN","","100","Select","Select",""],["","169406013","VICTOZA ","","9","Select","Select",""],["","8470113001","UNIFINE PENTIPS 31GX8MM","","150","Select","Select",""],["","59746012106","MECLIZINE HCL ","","30","Select","Select",""],["","597015230","JARDIANCE ","","-90","Select","Select",""],["","67877056105","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","51672130005","AMMONIUM LACTATE","","225","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM","","2","Select","Select",""],["","57599080000","FREESTYLE LIBRE 2\/SENSOR\/FLASH GLUCOSE MONITORING SYSTEM","","1","Select","Select",""],["","99073070805","FREESTYLE LITE BLOOD GLUCOSE MONITORING SYSTEM","","1","Select","Select",""],["","99073070827","FREESTYLE LITE TEST STRIPS","","100","Select","Select",""],["","8470355001","UNIFINE PENTIPS 31G X 3\/16\" ","","200","Select","Select",""],["","00024586903","TOUJEO SOLOSTAR","","15","Select","Select",""],["","00378395077","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN","","28","Select","Select",""],["","68180037703","LOSARTAN POTASSIUM","","-180","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","","28","Select","Select",""],["","59746012106","MECLIZINE HCL","","30","Select","Select",""],["","08470355001","UNIFINE PENTIPS 31G X 3\/16\"","","-200","Select","Select",""],["","60913000601","ALCOHOL PREP PADS","","300","Select","Select",""],["","60913000301","ADJUSTABLE LANCING DEVICE","","1","Select","Select",""],["","60913000101","AQUALANCE LANCETS UL TRA THIN 30G","30G","300","Select","Select",""],["","08396900700","CLICKFINE PEN NEEDLE 32GX5\/32\"","32GX5\/32","100","Select","Select",""],["","00054429931","FUROSEMIDE                                                            ","TAB 40MG","30","Select","Select",""],["","65862014405","CARVEDILOL                                                            ","TAB 12.5MG","270","Select","Select",""],["","00024586903","TOUJEO SOLOSTAR                                                       ","INJ 300IU\/ML","-15","Select","Select",""],["","00169406013","VICTOZA                                                               ","INJ 18MG\/3ML","9","Select","Select",""],["","08290320109","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM                              ","MIS 31GX8MM","200","Select","Select",""],["","16729000201","GLIMEPIRIDE                                                           ","TAB 2MG","90","Select","Select",""],["","00378395005","ATORVASTATIN CALCIUM                                                  ","TAB 10MG","90","Select","Select",""],["","68180037703","LOSARTAN POTASSIUM                                                    ","TAB 50MG","180","Select","Select",""],["","59746012106","MECLIZINE HCL                                                         ","TAB 25MG","-30","Select","Select",""],["","60432060416","PROMETHAZINE\/DEXTROMETHORPHAN                                         ","SYP DM","100","Select","Select",""],["","00597015960","SYNJARDY                                                              ","TAB 5-500MG","-180","Select","Select",""],["","00591544221","PREDNISONE                                                            ","PAK 10MG","21","Select","Select",""],["","00597015230","JARDIANCE                                                             ","TAB 10MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","Select","Select",""],["","08470113001","UNIFINE PENTIPS 31GX8MM                                               ","MIS 31GX8MM","-150","Select","Select",""],["","53746051105","SPIRONOLACTONE                                                        ","TAB 25MG","90","Select","Select",""],["","67877056105","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","-180","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","-1","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM                 ","MIS READER","2","Select","Select",""],["","51672130005","AMMONIUM LACTATE                                                      ","LOT 0.12","225","Select","Select",""],["","57599080000","FREESTYLE LIBRE 2\/SENSOR\/FLASH GLUCOSE MONITORING SYSTEM              ","KIT 2 SENSOR","1","Select","Select",""],["","99073070805","FREESTYLE LITE BLOOD GLUCOSE MONITORING SYSTEM                        ","MIS LITE","-1","Select","Select",""],["","99073070827","FREESTYLE LITE TEST STRIPS                                            ","TES LITE","100","Select","Select",""],["","08470355001","UNIFINE PENTIPS 31G X 3\/16\"                                           ","MIS 31GX3\/16","200","Select","Select",""],["","60913000101","AQUALANCE LANCETS UL     TRA THIN 30G                                 ","MIS 30G","300","Select","Select",""],["","60913000601","ALCOHOL PREP PADS                                                     ","PAD ","300","Select","Select",""],["","60913000301","ADJUSTABLE LANCING DEVICE                                             ","MIS ","1","Select","Select",""],["","08396900700","CLICKFINE PEN NEEDLE 32GX5\/32\"                                        ","MIS 32GX5\/32","100","Select","Select",""],["","08290328289","BD INSULIN SYRINGE ULTRA-FINE\/1ML\/31G X 8MM                           ","MIS 1ML\/31G","-200","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","",""],["No","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":""}]}]}