{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIELE   A SPARKS","gend":1,"add":"8500 TIDEWATER DR APT 11","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1982-04-14","age":"","mstatus":"","insh":"900035741*01","cliId":"6AK4CR7KT71","pno":"757\/966-8819","cno":"757\/966-8819","email":"","ename":"","eno":"","pphy":"SAMUELS, GARFIELD HUE MD","ppno":"757\/518-8823","pcpadd":"4452 CORPORATION LN STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":148049,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/518-8832","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R56.9","I10.","M54.9","R06.02","M79.662","G40.909","F31.11","Z79.899","E66.01","Z68.41","Z87.891","Z88.0","Z88.2","Z88.5","Z88.6","Z88.8","Z74.3","J45.901","D64.9","Z86.711","Z79.82","R07.9","R51.","Z86.73","B34.9","Z20.828","K21.9","F31.9","F17.210","R68.83","J02.9","R05.","R07.89","M79.10","J45.40","E66.9","J45.909","G89.29","M51.36","R55.","R07.2","J30.1","Z76.0","F30.9","E87.6","A08.4","Z82.5","Z82.61","Z81.8","Z83.71","Z83.3","Z82.62","Z83.49","Z82.49","H53.9","F12.10","F41.9","F17.200","Z79.84","Z79.51","J45.20","N39.0","G40.901","G40.301","S09.90XA","J44.9","R11.2","R03.0","R09.82","J30.9","G89.4","Z23.","E11.65","Z03.818","J20.9","J45.50","R19.7","R26.9","G47.9","F44.5","N30.91","R45.0","F41.1","R09.81","J34.89","K44.9","I82.403","F48.9","R07.81","E04.1","R10.30","Z86.718","R79.89","R00.0","T40.7X1A","T42.6X6A","E04.9","Z68.39","Z20.822","F12.90","F45.9","Z91.14","R07.1","R10.9"],"date":["2021-07-19","2021-07-19","2020-06-26","2021-06-04","2020-08-03","2021-06-04","2020-08-18","2020-11-11","2020-11-11","2021-03-04","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2020-08-18","2021-07-19","2020-12-08","2021-06-04","2021-05-10","2021-06-04","2021-06-05","2020-01-10","2021-03-04","2020-02-12","2020-07-08","2021-03-04","2021-05-18","2020-10-15","2020-02-12","2020-02-12","2020-07-08","2021-05-10","2020-02-12","2021-03-04","2021-06-04","2021-05-20","2021-05-18","2020-06-26","2020-02-24","2020-04-23","2020-05-12","2020-12-04","2020-02-27","2020-02-27","2020-02-27","2021-05-18","2021-05-18","2021-05-18","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-11-11","2020-11-11","2020-11-11","2021-05-18","2021-07-19","2021-03-04","2021-03-04","2019-09-21","2020-07-16","2021-05-20","2020-01-10","2020-01-10","2020-02-14","2021-07-19","2020-05-29","2019-08-23","2019-08-23","2020-01-11","2020-01-11","2020-01-15","2020-05-13","2020-05-13","2020-06-19","2020-02-24","2020-02-24","2020-02-24","2021-05-18","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-09-30","2021-05-18","2021-05-19","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-05-10","2021-06-04","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-07-19","2021-06-04","2021-07-20"],"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":[["","93031101","LOPERAMIDE","CAP 2MG","12","Select","Select",""],["","591024005","LORAZEPAM","TAB 0.5MG","10","Select","Select",""],["","406052201","OXYCOD\/APAP","TAB 7.5-325","-40","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","378827052","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","-12","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","60","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","93742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","378967130","IPRATROPIUM\/","SOL ALBUTER","-90","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505095303","AZEL\/FLUTIC","SPR 137-50","23","Select","Select",""],["","574110404","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","-10","Select","Select",""],["","69547035302","NARCAN","SPR ","-2","Select","Select",""],["","228202950","ALPRAZOLAM","TAB 0.5MG","20","Select","Select",""],["","31722053812","LEVETIRACETA","TAB 750MG","60","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","45","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","-30","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","-10","Select","Select",""],["","59779065034","TUSSIN ADULT","LIQ 100\/5ML","118","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","118","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68180011416","LEVETIRACETAM ","","60","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","42858010301","OXYCODONE\/ACETAMINOPHEN","","40","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","378827052","ALBUTEROL SULFATE","","75","Select","Select",""],["","378967130","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE ","","90","Select","Select",""],["","93031101","LOPERAMIDE HCL","","-12","Select","Select",""],["","186037020","SYMBICORT ","","10","Select","Select",""],["","591024005","LORAZEPAM ","","10","Select","Select",""],["","45802075930","PROMETHAZINE HCL","","12","Select","Select",""],["","10702002501","PHENTERMINE HCL ","","30","Select","Select",""],["","69238126601","OSELTAMIVIR PHOSPHATE","","10","Select","Select",""],["","16729018201","HYDROCHLOROTHIAZIDE","","30","Select","Select",""],["","59779065034","CVS TUSSIN ADULT CHEST CONGESTION ","","118","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE ","","10","Select","Select",""],["","51991081403","AZELASTINE HYDROCHLORIDE","","30","Select","Select",""],["","58657050016","CODEINE\/GUAIFENESIN","","118","Select","Select",""],["","574110404","BROMPHEN\/PSEUDOEPHEDRINE HCL\/DEXTROMETHORPHAN HBR ","","120","Select","Select",""],["","60505095303","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE","","23","Select","Select",""],["","93742698","MONTELUKAST SODIUM ","","30","Select","Select",""],["","57237007710","ONDANSETRON ODT ","","12","Select","Select",""],["","13811071910","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","","14","Select","Select",""],["","65162052110","PROMETHAZINE HYDROCHLORIDE","","12","Select","Select",""],["","310737220","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","","10","Select","Select",""],["","10702002501","PHENTERMINE HCL","","30","Select","Select",""],["","00378967130","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE","","-30","Select","Select",""],["","68180011416","LEVETIRACETAM","","-60","Select","Select",""],["","59779065034","CVS TUSSIN ADULT CHEST CONGESTION","","118","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE","","10","Select","Select",""],["","00574110404","BROMPHEN\/PSEUDOEPHEDRINE HCL\/DEXTROMETHORPHAN HBR","","120","Select","Select",""],["","00093742698","MONTELUKAST SODIUM","","30","Select","Select",""],["","57237007710","ONDANSETRON ODT","","12","Select","Select",""],["","59779065034","TUSSIN","100\/5ML","118","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65862049101","QUETIAPINE","100MG","120","Select","Select",""],["","65862019405","FLUOXETINE","40MG","120","Select","Select",""],["","00310737220","BUDES\/FORMOT","80-4.5","10","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","",""],["No","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":""}]}]}