{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAROLD   D COSTON","gend":0,"add":"305 SAINT THOMAS DR APT F","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1951-02-11","age":"","mstatus":"","insh":"900036881*01","cliId":"2AJ5KA9YK83","pno":"757\/218-9628","cno":"757\/218-9628","email":"","ename":"","eno":"","pphy":"LOUIS, CLAUDE MD","ppno":"757\/827-1940","pcpadd":"2148 WEST MERCURY BLVD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Medical Care Center - Mercury West","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"757\/579-0701","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/896-4715","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D70.9","D69.3","D50.9","Z00.00","Z13.6","I10.","I50.22","E78.2","Z12.5","Z12.11","Z86.010","I11.0","I50.9","C37.","G62.89","R76.9","D69.6","I25.10","K13.79","Z01.818","R19.5","D62.","R41.82","N50.82","I62.9","G93.9","I50.20","J98.59","G93.40","N28.9","D64.9","Z98.890","J98.4","I51.89","Z23.","C93.10","L03.114","Z13.39","K14.8","M25.50","M79.10","R03.0","R73.9","T14.90XA","Z74.3","R22.2","R06.81","R47.01","J96.01","I61.9","D12.6","K57.30","K64.8","G93.6","D72.829","E87.5","E87.1","E43.","I63.9","I67.1","I61.1","J90.","D49.9","J94.8","J18.9","R06.02","Z51.12","Z11.3","K13.4","G93.5","I46.9","I21.29","I13.0","J98.11","K92.2","E46.","N17.9","I30.9","V89.9XXA","R41.3","R41.0","E55.9","E78.5","C38.3","Z03.89","G62.9","G31.84","K76.9","H40.013","L98.8","L76.82","D75.89","J98.6","J80.","N52.9","G56.00","Z95.1","S06.309D","R16.0","D68.62","E29.1","R40.2362","R40.2142","R40.2252","D50.0","I51.3","K12.1","Z79.01","K13.0","R58.","D86.9","D38.3","I51.7","I31.3","R06.82","R07.9","J18.1","R06.9","R91.8","R06.00","Z51.5","Z71.89","Z90.89","I48.0","I48.91","J96.90","I21.19","D10.0","V89.2XXA","I21.3","I25.2","Z99.81","C92.10","J84.10","E04.1","R60.0"],"date":["2021-10-27","2021-10-27","2021-11-10","2021-11-10","2021-02-12","2021-11-10","2021-02-08","2021-11-10","2021-02-08","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-11-10","2021-10-27","2021-06-09","2021-11-10","2021-11-10","2020-03-10","2020-03-04","2020-05-08","2020-03-18","2020-04-06","2020-04-01","2020-05-08","2020-04-08","2021-11-10","2020-04-08","2020-04-08","2020-04-08","2020-05-06","2020-04-11","2020-04-11","2020-05-01","2021-10-27","2021-06-02","2020-02-07","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-03-16","2020-03-16","2020-03-30","2020-04-14","2020-04-14","2020-05-06","2020-05-01","2020-06-19","2021-04-23","2021-04-23","2020-04-06","2020-04-07","2020-04-06","2020-04-06","2020-04-06","2020-04-14","2020-04-14","2020-04-14","2020-06-19","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2021-08-11","2020-02-05","2020-02-20","2020-03-16","2020-04-15","2020-03-16","2020-03-16","2021-09-15","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-04-10","2020-03-17","2020-03-17","2021-11-10","2021-09-01","2020-04-01","2020-04-13","2020-04-24","2021-11-10","2020-06-19","2021-10-29","2020-03-11","2020-03-12","2020-03-25","2020-04-14","2020-04-10","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-07-29","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-03-10","2020-03-17","2020-03-17","2020-03-30","2020-04-06","2020-04-06","2020-04-16","2020-04-30","2020-04-06","2020-04-06","2020-04-10","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-15","2020-04-15","2020-04-15","2020-04-15","2020-03-10","2020-03-16","2020-04-05","2020-04-11","2020-05-06","2021-09-15","2021-09-15","2021-09-15","2021-09-15"],"priorHcc":[null,null,null,null,"",null,"",null,"","","","","",null,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":[["","00143924920","AMOX\/K ","875-125","-20","Select","Select",""],["","69097094605","ATORVASTATIN ","40MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","-8","Select","Select",""],["","68382009305","CARVEDILOL ","6.25MG","60","Select","Select",""],["","00904759080","FEROSUL ","325MG","90","Select","Select",""],["","00487020103","IPRATROPIUM\/ ","ALBUTER","180","Select","Select",""],["","67877022401","GABAPENTIN ","400MG","180","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","75","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90","Select","Select",""],["","43547035110","LISINOPRIL ","2.5MG","90","Select","Select",""],["","0","","","300","Select","Select",""],["","31722053712","LEVETIRACETA ","500MG","180","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","58160084252","BOOSTRIX ","","0","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","40","Select","Select",""],["","11822035790","RA ","27MG","90","Select","Select",""],["","00078068615","PROMACTA ","50MG","30","Select","Select",""],["","00143924920","AMOX\/K","875-125","-20","Select","Select",""],["","69097094605","ATORVASTATIN","40MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","-12","Select","Select",""],["","00487020103","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","-75","Select","Select",""],["","43547035110","LISINOPRIL","2.5MG","90","Select","Select",""],["","31722053712","LEVETIRACETA","500MG","180","Select","Select",""],["","00904759080","FEROSUL","325MG","90","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","90","Select","Select",""],["","67877022401","GABAPENTIN","400MG","180","Select","Select",""],["","68382009301","CARVEDILOL","6.25MG","180","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","70461012003","FLUAD","0.5ML","0","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","-40","Select","Select",""],["","11822035790","RA","27MG","90","Select","Select",""],["","00078068615","PROMACTA","50MG","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":[[["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":""}]}]}