{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   J PETERS","gend":0,"add":"3100 EAST OCEAN VIEW AVE APT A","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1973-06-29","age":"","mstatus":"","insh":"900035989*01","cliId":"3U93CK6RN78","pno":"757\/951-6449","cno":"757\/951-6449","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L40.50","F32.9","F41.9","M15.9","Z79.899","F32.1","F10.21","E03.9","F41.1","L40.9","E11.9","K21.9","Z86.010","M70.22","E78.5","Z87.891","Z82.61","L53.9","Z00.00","F98.8","Z23.","M99.01","M99.03","L40.8","L03.114","L30.9","N52.9","B35.9","E78.00","D84.9","R68.89"],"date":["2021-10-04","2021-10-13","2021-08-23","2021-09-28","2021-02-01","2021-04-08","2021-04-08","2021-08-23","2021-04-08","2020-08-24","2021-08-23","2020-10-30","2020-10-30","2019-09-23","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2021-08-23","2021-08-23","2021-09-28","2021-09-30","2021-09-30","2021-02-25","2019-09-10","2020-06-16","2020-02-24","2020-08-25","2021-08-23","2021-09-28","2020-07-15"],"priorHcc":[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":[["","54455015","METHOTREXATE","TAB 2.5MG","32","Select","Select",""],["","378400505","ALPRAZOLAM","TAB 1MG","-60","Select","Select",""],["","406889401","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","16714070001","LAMOTRIGINE","TAB 25MG","30","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","90","Select","Select",""],["","60505257809","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","65862021150","MINOCYCLINE","CAP 100MG","30","Select","Select",""],["","42571017701","PIROXICAM","CAP 20MG","-30","Select","Select",""],["","43386002860","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","45802056202","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","21","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","64764073030","TRINTELLIX","TAB 10MG","30","Select","Select",""],["","68462051339","DESONIDE","LOT 0.0005","-60","Select","Select",""],["","68180097101","LEVOTHYROXIN","TAB 125MCG","90","Select","Select",""],["","57896020401","ACETAMINOPHE","TAB 500MG","180","Select","Select",""],["","31722064430","TADALAFIL","TAB 5MG","6","Select","Select",""],["","59746017206","PREDNISONE","TAB 5MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","-1","Select","Select",""],["","472011745","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","65162036110","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","57844013001","ADDERALL","TAB 30MG","60","Select","Select",""],["","65862021150","MINOCYCLINE HYDROCHLORIDE ","","30","Select","Select",""],["","378046701","PIROXICAM ","","30","Select","Select",""],["","13107007401","AMPHETAMINE\/DEXTROAMPHETAMINE","","60","Select","Select",""],["","45802056202","CLINDAMYCIN PHOSPHATE","","-60","Select","Select",""],["","68180097101","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","60505257809","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","63304069205","CLINDAMYCIN HYDROCHLORIDE ","","90","Select","Select",""],["","43386002860","CLOBETASOL PROPIONATE","","50","Select","Select",""],["","472011745","TRETINOIN ","","45","Select","Select",""],["","31722064430","TADALAFIL ","","6","Select","Select",""],["","57896020401","ACETAMINOPHEN EXTRA STRENGTH","","180","Select","Select",""],["","65862007930","TERBINAFINE HCL ","","21","Select","Select",""],["","67877032105","IBUPROFEN ","","90","Select","Select",""],["","65862021150","MINOCYCLINE HYDROCHLORIDE","","30","Select","Select",""],["","63304069205","CLINDAMYCIN HYDROCHLORIDE","","90","Select","Select",""],["","60505257809","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","68180097101","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","65862007930","TERBINAFINE HCL","","21","Select","Select",""],["","00527133701","BACLOFEN","20MG","30","Select","Select",""],["","59267100003","PFIZER-BIONTECH COVID-19 VACCINE","COVID-19","0","Select","Select",""],["","65862021150","MINOCYCLINE HYDROCHLORIDE                                             ","CAP 100MG","30","Select","Select",""],["","68462051339","DESONIDE                                                              ","LOT 0.0005","60","Select","Select",""],["","64764017530","DEXILANT                                                              ","CAP 60MG DR","-90","Select","Select",""],["","00406889401","AMPHETAMINE\/DEXTROAMPHETAMINE                                         ","TAB 30MG","60","Select","Select",""],["","68180097101","LEVOTHYROXINE SODIUM                                                  ","TAB 125MCG","-90","Select","Select",""],["","29300011101","LAMOTRIGINE                                                           ","TAB 25MG","30","Select","Select",""],["","64764073030","TRINTELLIX                                                            ","TAB 10MG","30","Select","Select",""],["","00378400505","ALPRAZOLAM                                                            ","TAB 1MG","-60","Select","Select",""],["","43386002860","CLOBETASOL PROPIONATE                                                 ","SOL 0.0005","50","Select","Select",""],["","45802056202","CLINDAMYCIN PHOSPHATE                                                 ","SOL 0.01","60","Select","Select",""],["","42571017701","PIROXICAM                                                             ","CAP 20MG","30","Select","Select",""],["","00054455015","METHOTREXATE                                                          ","TAB 2.5MG","32","Select","Select",""],["","60505257809","ATORVASTATIN CALCIUM                                                  ","TAB 10MG","90","Select","Select",""],["","65862007930","TERBINAFINE HCL                                                       ","TAB 250MG","21","Select","Select",""],["","31722064430","TADALAFIL                                                             ","TAB 5MG","6","Select","Select",""],["","67877032105","IBUPROFEN                                                             ","TAB 800MG","90","Select","Select",""],["","51672129801","KETOCONAZOLE                                                          ","CRE 0.02","15","Select","Select",""],["","57896020401","ACETAMINOPHEN EXTRA STRENGTH                                          ","TAB 500MG","180","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","1","Select","Select",""],["","69315012701","FOLIC ACID                                                            ","TAB 1000MCG","90","Select","Select",""],["","57844013001","ADDERALL                                                              ","TAB 30MG","60","Select","Select",""],["","59267100003","PFIZER-BIONTECH COVID-19 VACCINE                                      ","INJ COVID-19","0","Select","Select",""],["","59746017206","PREDNISONE                                                            ","TAB 5MG","30","Select","Select",""],["","00527133701","BACLOFEN                                                              ","TAB 20MG","30","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":""}]}]}