{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   C LIKENS","gend":1,"add":"103 MOON DR","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1946-12-24","age":"","mstatus":"","insh":"900036707*01","cliId":"8PF2HM8XG88","pno":"757\/357-6239","cno":"757\/357-6239","email":"","ename":"","eno":"","pphy":"POPE, THOMAS C MD","ppno":"757\/357-3331","pcpadd":"201 GUMWOOD DR","pcpcity":"SMITHFIELD","pcpstate":"VA","pcpzip":23430,"pcpcounty":"","pcpid":131791,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-1006","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.9","D51.8","C50.911","C50.919","Z17.1","I87.8","Z85.3","E78.2","I10.","Z79.01","C50.411","M54.17","R20.2","E53.8","Z95.828","I25.10","Z12.11","M54.16","M43.16","Z12.39","C77.0","J34.0","Z12.31","Z98.890","R53.83","Z79.899","D51.9","I50.9","I47.1","R06.00","M54.5","R10.9","K57.30","N28.1","N83.201","F32.89","Z00.00","Z68.25","Z13.89","M47.27","M47.26","M48.061","M48.07","M51.16","M51.17","Z23.","I48.0","I48.91","J44.1","J31.0","E78.5","K21.9","Z86.718","F48.9","R06.09","I42.9","Z68.26","I50.23","R07.9","M79.605"],"date":["2020-01-06","2021-03-25","2020-02-10","2020-02-10","2021-08-24","2020-02-19","2021-09-23","2021-07-15","2021-07-15","2021-11-09","2021-08-24","2020-08-31","2020-08-31","2020-11-05","2020-02-19","2021-05-18","2021-05-23","2020-11-04","2020-12-31","2021-03-08","2020-03-09","2020-03-09","2021-07-06","2020-07-01","2021-09-14","2021-06-24","2021-06-24","2021-05-18","2021-05-18","2020-02-04","2020-06-23","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-07-15","2021-07-15","2021-09-14","2021-07-15","2020-08-22","2020-12-31","2020-08-22","2020-08-22","2020-08-22","2020-08-22","2021-11-01","2020-12-07","2021-04-30","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-05-04","2021-05-18","2021-07-15","2021-07-15","2021-05-04","2021-09-14"],"priorHcc":["","","","","","",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":[["","51991077290","LANSOPRAZOLE ","30MG DR","30","Select","Select",""],["","76385011250","CARVEDILOL ","12.5MG","180","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","60","Select","Select",""],["","65862032904","ALENDRONATE ","70MG","12","Select","Select",""],["","00378021610","FUROSEMIDE ","40MG","90","Select","Select",""],["","57237001830","DULOXETINE ","30MG","270","Select","Select",""],["","00093172110","WARFARIN ","5MG","-54","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","16729000517","SIMVASTATIN ","20MG","90","Select","Select",""],["","00078077720","ENTRESTO ","49-51MG","180","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","40","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","65862032904","","70MG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","-60","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","90","Select","Select",""],["","65862032904","ALENDRONATE","70MG","12","Select","Select",""],["","76385011250","CARVEDILOL","12.5MG","180","Select","Select",""],["","51991077290","LANSOPRAZOLE","30MG DR","30","Select","Select",""],["","00093172110","WARFARIN","5MG","-54","Select","Select",""],["","57237001830","DULOXETINE","30MG","270","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","16729000517","SIMVASTATIN","20MG","90","Select","Select",""],["","00078077720","ENTRESTO","49-51MG","180","Select","Select",""],["","68462010530","ONDANSETRON","4MG","40","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","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":""}]}]}