{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARION   C HINTON","gend":1,"add":"4815 DEMING CT","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1948-03-15","age":"","mstatus":"","insh":"900038144*01","cliId":"3DN2HD0WT83","pno":"757\/802-8978","cno":"757\/802-8978","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","M16.0","I50.89","M62.81","G89.4","M19.90","I10.","M72.0","M16.11","M47.816","M17.10","M06.9","M16.9","M15.9","M10.9","N39.41","R15.9","L22.","Z79.891","R26.2","M25.551","M19.019","R60.0","Z74.09","R01.1","I08.0","Z99.3","B37.2","G62.9","E87.6","K21.9","E55.9","D64.9","E78.5","F33.9","R51.9","K59.00","R60.9","D50.9","E66.9","E83.52","I42.9","M16.10","L81.9","M51.36","M51.37","Z12.11","R14.0","R05.","M17.0"],"date":["2020-02-05","2020-10-21","2020-10-21","2021-05-06","2021-08-26","2020-04-08","2021-05-07","2020-04-08","2021-05-07","2021-08-26","2021-05-07","2021-08-26","2021-03-10","2021-06-01","2021-01-07","2021-03-13","2021-03-13","2021-03-13","2021-08-30","2021-05-06","2021-03-29","2021-03-10","2021-05-11","2021-05-07","2020-07-16","2020-07-16","2020-08-31","2020-06-19","2020-06-19","2020-06-19","2020-06-19","2020-06-19","2021-05-07","2021-05-07","2021-03-18","2020-12-07","2021-08-30","2020-12-10","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-06","2021-05-07","2021-05-07","2021-05-07","2021-07-07","2021-08-30","2021-08-30","2021-08-26"],"priorHcc":["","","","",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":[["","51672126303","NYSTAT\/TRIAM","CRE ","60","Select","Select",""],["","406052301","OXYCOD\/APAP","TAB 10-325MG","120","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","52565005504","CLOBETASOL","LOT 0.0005","118","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","245531911","KLOR-CON M20","TAB 20MEQ ER","90","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","68308015260","NYSTATIN","POW 100000","60","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","90","Select","Select",""],["","574709312","HYDROCORT AC","SUP 30MG","12","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","50428026496","CVS SENNA","TAB 8.6MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","59779030603","CVS PURELAX","POW ","510","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","50428039731","ANTI-ITCH","LOT 0.5-0.5%","222","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","7","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","42858010401","OXYCODONE\/ACETAMINOPHEN","","120","Select","Select",""],["","49884093547","DICLOFENAC SODIUM","","200","Select","Select",""],["","69452015120","VITAMIN D ","","12","Select","Select",""],["","51991074790","DULOXETINE HCL","","90","Select","Select",""],["","45802048678","DOCUSATE SODIUM ","","30","Select","Select",""],["","51672126303","NYSTATIN\/TRIAMCINOLONE","","60","Select","Select",""],["","59651000305","OMEPRAZOLE DR ","","90","Select","Select",""],["","574709312","HYDROCORTISONE ACETATE","","12","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE","","454","Select","Select",""],["","50428026496","CVS SENNA ","","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","","90","Select","Select",""],["","50428039731","CVS ANTI-ITCH ","","222","Select","Select",""],["","42806016005","HYDROXYZINE HYDROCHLORIDE ","","90","Select","Select",""],["","52565005504","CLOBETASOL PROPIONATE","","118","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE","","30","Select","Select",""],["","45802048678","DOCUSATE SODIUM","","30","Select","Select",""],["","59651000305","OMEPRAZOLE DR","","90","Select","Select",""],["","42806016005","HYDROXYZINE HYDROCHLORIDE","","90","Select","Select",""],["","50428039731","CVS ANTI-ITCH","","222","Select","Select",""],["","57896055510","SENNA-PLUS","","30","Select","Select",""],["","00904672580","SENNA","","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","45","Select","Select",""],["","65649015090","RELISTOR","150MG","90","Select","Select",""],["","51991074790","DULOXETINE HCL                                                        ","CAP 30MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE                                                            ","CAP 20MG","90","Select","Select",""],["","69097094312","GABAPENTIN                                                            ","CAP 300MG","270","Select","Select",""],["","42858010401","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 10-325MG","120","Select","Select",""],["","59779030603","CVS PURELAX                                                           ","POW ","510","Select","Select",""],["","45802048678","DOCUSATE SODIUM                                                       ","CAP 100MG","30","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","4","Select","Select",""],["","51672126303","NYSTATIN\/TRIAMCINOLONE                                                ","CRE ","60","Select","Select",""],["","00245531911","KLOR-CON M20                                                          ","TAB 20MEQ ER","90","Select","Select",""],["","00574709312","HYDROCORTISONE ACETATE                                                ","SUP 30MG","12","Select","Select",""],["","68180051703","LISINOPRIL                                                            ","TAB 40MG","90","Select","Select",""],["","68308015260","NYSTATIN                                                              ","POW 100000","60","Select","Select",""],["","49884093547","DICLOFENAC SODIUM                                                     ","GEL 0.01","200","Select","Select",""],["","00378064205","PREDNISONE                                                            ","TAB 20MG","7","Select","Select",""],["","00378020810","FUROSEMIDE                                                            ","TAB 20MG","90","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE                                               ","CRE 0.001","454","Select","Select",""],["","59651000305","OMEPRAZOLE DR                                                         ","CAP 40MG","90","Select","Select",""],["","50428026496","CVS SENNA                                                             ","TAB 8.6MG","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE                                                   ","TAB 10MG","90","Select","Select",""],["","10702001150","HYDROXYZINE HYDROCHLORIDE                                             ","TAB 25MG","30","Select","Select",""],["","52565005504","CLOBETASOL PROPIONATE                                                 ","LOT 0.0005","118","Select","Select",""],["","50428039731","CVS ANTI-ITCH                                                         ","LOT 0.5-0.5%","222","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE                                              ","CAP 60MG","30","Select","Select",""],["","69547035302","NARCAN                                                                ","SPR ","2","Select","Select",""],["","57896055510","SENNA-PLUS                                                            ","TAB 8.6-50MG","30","Select","Select",""],["","65649015090","RELISTOR                                                              ","TAB 150MG","90","Select","Select",""],["","00904672580","SENNA                                                                 ","TAB 8.6MG","30","Select","Select",""],["","67877057305","BENZONATATE                                                           ","CAP 100MG","45","Select","Select",""],["","00121087316","LACTULOSE                                                             ","SOL 10GM\/15","946","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","36","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":""}]}]}