{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IRIS   S HILL","gend":1,"add":"173 FAIRWIND DR APT 104","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1959-04-20","age":"","mstatus":"","insh":"900036552*01","cliId":"9QQ9EN3RF25","pno":"803\/317-7479","cno":"803\/317-7479","email":"","ename":"","eno":"","pphy":"PATEL, SONAL MD","ppno":"757\/738-1350","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":207887,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-5450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E03.9","Z12.39","R73.03","E66.01","Z68.42","M05.79","M15.9","M25.531","D84.9","N89.8","M25.432","M25.532","M06.9","M17.0","Z96.653","M75.121","M25.511","S43.81XA","M19.012","G47.33","G58.9","E53.8","E78.5","R53.1","R20.0","M79.7","Z79.899","G47.30","E66.9","Z98.84","Z12.11","M25.561","M25.562","J45.909","Z86.79","R07.9","R06.02","R05.","E07.9","D64.9","Z20.828","Z82.49","R71.8","D50.9","Z23.","M19.032","R93.7","J30.9","M65.812","M25.512","Z20.822","R11.0","Z83.49","Z79.52","Z11.1","M05.731","R91.1"],"date":["2021-08-05","2020-11-10","2020-02-28","2020-11-10","2020-02-28","2020-08-05","2021-11-19","2021-11-19","2021-05-20","2021-11-19","2021-05-21","2020-02-11","2020-03-31","2021-08-05","2020-11-09","2021-08-05","2021-08-16","2021-08-16","2021-04-27","2021-05-23","2020-07-09","2020-03-31","2020-11-10","2020-11-10","2020-03-31","2020-03-31","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-05-23","2020-10-22","2020-10-22","2021-08-05","2020-12-29","2020-12-30","2020-12-29","2021-08-05","2021-08-05","2020-07-28","2020-08-05","2021-08-05","2020-09-04","2020-09-10","2021-09-27","2020-02-11","2020-02-11","2020-07-30","2021-05-24","2021-05-24","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-09-16","2021-09-23","2021-09-16"],"priorHcc":["","","","","","",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":[["","00074055402","HUMIRA ","40\/0.4ML","6","Select","Select",""],["","47335023583","METHOTREXATE ","2.5MG","120","Select","Select",""],["","00781518992","LEVOTHYROXIN ","200MCG","90","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","90","Select","Select",""],["","43547038103","DULOXETINE ","60MG","30","Select","Select",""],["","70069000510","CYANOCOBALAM ","1000MCG","1","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90","Select","Select",""],["","00904052360","VITAMIN ","500MG","45","Select","Select",""],["","69315012710","FOLIC ","1000MCG","90","Select","Select",""],["","72305020030","EUTHYROX ","200MCG","90","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00093505998","ATORVASTATIN ","20MG","90","Select","Select",""],["","00591505210","PREDNISONE ","5MG","30","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","-10","Select","Select",""],["","57896070310","IRON ","325MG","90","Select","Select",""],["","00245010810","FERROUS ","325MG EC","45","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","31604003175","","","90","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","600MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","069097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","066993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","049035045875","ALLERGY ","10MG","90","Select","Select",""],["","00074055402","HUMIRA","40\/0.4ML","-2","Select","Select",""],["","00054455025","METHOTREXATE","2.5MG","40","Select","Select",""],["","00781518992","LEVOTHYROXIN","200MCG","-30","Select","Select",""],["","57237001930","DULOXETINE","60MG","-90","Select","Select",""],["","29300022019","MONTELUKAST","10MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","68645051654","AMLODIPINE","10MG","90","Select","Select",""],["","72305002530","EUTHYROX","25MCG","90","Select","Select",""],["","00904052360","VITAMIN","500MG","45","Select","Select",""],["","57896070310","IRON","325MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","70069000510","CYANOCOBALAM","1000MCG","1","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00591505210","PREDNISONE","5MG","30","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","00093505998","ATORVASTATIN","20MG","-90","Select","Select",""],["","00245010810","FERROUS","325MG EC","45","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","68645056259","IBUPROFEN","600MG","20","Select","Select",""],["","16571040250","CETIRIZINE","10MG","90","Select","Select",""],["","49035045875","ALLERGY","10MG","90","Select","Select",""],["","69097014260","ALBUTEROL","HFA","-7","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","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","",""],["Yes","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":""}]}]}