{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHEILA   A KIRVEN","gend":1,"add":"27 SUMMERWOOD DR","city":"STAFFORD","state":"VA","zip":"22554-9998","dob":"1967-07-30","age":"","mstatus":"","insh":"900036110*01","cliId":"5GG9FD8DF10","pno":"571\/359-2148","cno":"571\/359-2148","email":"","ename":"","eno":"","pphy":"ANBESSIE, TEDLA MD","ppno":"540\/657-9191","pcpadd":"2765 JEFFERSON DAVIS H SUITE 109","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":22554,"pcpcounty":"","pcpid":128014,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/657-0986","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.12","Z47.1","I10.","F41.9","F31.9","R73.03","K58.9","K44.9","K21.9","K59.00","E78.00","Z96.652","Z91.81","M25.562","F39.","F60.3","Z12.11","F13.231","R45.851","Z11.59","Z86.79","T43.222A","E78.5","F10.10","F43.10","Z20.828","Z88.6","Z63.9","Z60.9","Z91.5","F10.221","R00.0","Z73.3","R10.30","R10.32","Z90.49","R10.9","M54.5","M47.892","Z01.818","M25.561","M17.11","M25.50","Z83.49","Z83.430","E55.9","D51.9","F10.11","F14.11","F41.1","G47.00","R14.0","R10.13","R12.","R63.4","R19.8","K62.5","G89.29","F41.8","Z86.010","Z88.8","M24.662","F32.9","T44.7X2S","Z23.","K63.89","K38.9","R42.","F41.0","R09.89","R51.","T50.902A","M54.9","R53.82","H53.8","G89.4","K58.2","Z79.899","K35.80","R10.84","D72.829","E78.2","K21.0","K50.90","M10.042","M17.9"],"date":["2020-11-20","2020-02-11","2021-06-28","2021-01-12","2021-05-06","2020-07-17","2020-02-11","2021-03-02","2020-02-11","2020-02-11","2020-09-08","2020-09-08","2020-02-11","2020-10-15","2020-09-17","2020-09-08","2021-05-23","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-06-28","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-10","2019-10-08","2019-10-22","2020-07-17","2020-07-17","2021-03-18","2020-07-17","2020-10-15","2020-10-15","2020-01-08","2019-12-04","2019-12-04","2021-06-28","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2020-10-22","2020-10-22","2021-02-11","2020-02-06","2020-04-28","2021-01-12","2020-04-28","2020-04-28","2020-04-28","2021-01-12","2020-10-09","2020-01-14","2020-01-14","2020-01-14","2020-06-03","2021-03-02","2020-09-08","2020-10-15","2021-03-02","2021-03-02","2020-11-20","2019-10-01","2019-10-19","2019-10-19","2020-09-07","2021-06-28","2020-11-20","2020-11-20","2020-11-20","2021-01-12","2021-06-28","2021-03-03","2021-03-02","2021-03-02","2020-06-19","2020-06-19","2021-03-02","2021-06-28","2021-06-28"],"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":[["","456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","527128201","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","-90","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","406324301","HYDROMORPHON","TAB 2MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","90","Select","Select",""],["","65862078430","ESOMEPRA MAG","CAP 40MG DR","90","Select","Select",""],["","68645056854","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","68382009205","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","90","Select","Select",""],["","68180021709","LOSARTAN\/HCT","TAB 100-25","30","Select","Select",""],["","63304044990","FENOFIBRATE","TAB 145MG","31","Select","Select",""],["","2791701941",""," ","100","Select","Select",""],["","49281072010","FLUBLOK QUAD","INJ 2020-21","0","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","69784050001","EC-NAPROXEN","TAB 500MG","-40","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","45","Select","Select",""],["","591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","43386005019","GAVILYTE-N","SOL FLAV PK","-4000","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","30","Select","Select",""],["","904576960","ARTHRTS PAIN","TAB 650MG","90","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","-354","Select","Select",""],["","46122062978","8 HR ARTHRTS","TAB 650MG","60","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","90","Select","Select",""],["","185067405","HYDROXYZ PAM","CAP 25MG","62","Select","Select",""],["","573286810","PREPARATION","CRE H","26","Select","Select",""],["","69543042610","NAPROXEN DR","TAB 500MG","40","Select","Select",""],["","378064010","PREDNISONE","TAB 5MG","15","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","406012301","HYDROCO\/APAP","TAB 5-325MG","60","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","45802043803","HYDROCORT","CRE 0.01","28","Select","Select",""],["","50428057834","CVS PAIN REL","PAD 0.04","5","Select","Select",""],["","61874013030","VRAYLAR ","","-30","Select","Select",""],["","65862078430","ESOMEPRAZOLE MAGNESIUM","","60","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE ","","30","Select","Select",""],["","456120130","LINZESS ","","-30","Select","Select",""],["","50111043301","TRAZODONE HYDROCHLORIDE","","30","Select","Select",""],["","31722070210","LOSARTAN POTASSIUM ","","90","Select","Select",""],["","68645056854","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","68382005105","MELOXICAM ","","-90","Select","Select",""],["","42858030101","HYDROMORPHONE HCL","","5","Select","Select",""],["","69097084507","CYCLOBENZAPRINE HYDROCHLORIDE","","15","Select","Select",""],["","16714061201","SERTRALINE HCL","","30","Select","Select",""],["","591352530","LIDOCAINE ","","30","Select","Select",""],["","50458058030","XARELTO ","","30","Select","Select",""],["","64380078706","BUSPIRONE HYDROCHLORIDE","","-90","Select","Select",""],["","527128201","DICYCLOMINE HYDROCHLORIDE ","","60","Select","Select",""],["","68645052354","SERTRALINE HYDROCHLORIDE","","30","Select","Select",""],["","43386005019","GAVILYTE-N\/FLAVOR PACK","","4000","Select","Select",""],["","68180021709","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","","30","Select","Select",""],["","406012301","HYDROCODONE\/ACETAMINOPHEN ","","60","Select","Select",""],["","50428057834","CVS PAIN RELIEF MAXIMUM STRENGTH","","5","Select","Select",""],["","65162044210","MECLIZINE HYDROCHLORIDE","","30","Select","Select",""],["","49281072010","FLUBLOK QUADRIVALENT 2020-2021","","0","Select","Select",""],["","904576960","MAPAP ARTHRITIS PAIN ","","90","Select","Select",""],["","52268001201","SUPREP BOWEL PREP KIT","","354","Select","Select",""],["","46122062978","GNP 8 HOUR ARTHRITIS RELIEF ","","60","Select","Select",""],["","185067405","HYDROXYZINE PAMOATE","","62","Select","Select",""],["","42806001401","MECLIZINE HCL ","","30","Select","Select",""],["","45802043803","HYDROCORTISONE","","28","Select","Select",""],["","573286810","PREPARATION H ","","26","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL 3350","","510","Select","Select",""],["","13668021730","ARIPIPRAZOLE","","31","Select","Select",""],["","63739044001","ACETAMINOPHEN ","","30","Select","Select",""],["","57896064912","MILK OF MAGNESIA","","355","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE","","-30","Select","Select",""],["","00527128201","DICYCLOMINE HYDROCHLORIDE","","60","Select","Select",""],["","31722070210","LOSARTAN POTASSIUM","","90","Select","Select",""],["","68645056854","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN","","60","Select","Select",""],["","00904576960","MAPAP ARTHRITIS PAIN","","90","Select","Select",""],["","00573286810","PREPARATION H","","26","Select","Select",""],["","63739044001","ACETAMINOPHEN","","30","Select","Select",""],["","42806001401","MECLIZINE HCL","","30","Select","Select",""],["","46122062978","GNP 8 HOUR ARTHRITIS RELIEF","","60","Select","Select",""],["","69097012615","AMLODIPINE BESYLATE","","31","Select","Select",""],["","69618004610","ASPIRIN ADULT LOW STRENGTH","","31","Select","Select",""],["","00832105410","BACLOFEN","","-60","Select","Select",""],["","55111072901","ALLOPURINOL","","90","Select","Select",""],["","59779060027","CVS ASPIRIN LOW DOSE","","64","Select","Select",""],["","69842031278","CVS 8HR MUSCLE ACHES & PAIN","650MG","90","Select","Select",""],["","59779045806","CVS INDOOR\/OUTDOOR ALLERGY RELIEF","10MG","90","Select","Select",""],["","42806016105","HYDROXYZINE HCL","50MG","90","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":""}]}]}