{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MORTON   J GLASSER","gend":0,"add":"4765 OPEN GREENS DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1928-03-21","age":"","mstatus":"","insh":"900038251*01","cliId":"9A35J81XV60","pno":"757\/495-6678","cno":"757\/495-6678","email":"","ename":"","eno":"","pphy":"SALSANO, ALESSIO C MD","ppno":"757\/495-4353","pcpadd":"5265 PROVIDENCE RD STE 401","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":210630,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/495-4560","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.3","R91.8","D49.89","I44.2","Z95.0","I48.91","I10.","E78.5","R60.0","E78.2","S33.5XXA","E66.9","R60.9","N40.0","R04.0","Z79.01","N28.9","Q60.0","C64.1","N40.1","D48.5","R16.0","K80.20","N18.30","E55.9","N28.89","K76.89","Z90.5","E66.3","M10.9","I48.0","Z68.33","M1A.9XX0","Z91.81","R73.9","J98.11","K44.9","Q44.6","C44.722","D23.5","H04.123","H43.813","Z96.1","H26.492","Z23.","Z00.00","N13.8","Z71.89","N26.1","N28.1","Z98.890","R10.9","K76.0"],"date":["2020-09-18","2020-02-24","2020-03-09","2020-07-22","2021-09-16","2021-06-16","2021-04-28","2021-07-13","2021-03-18","2020-08-12","2021-07-05","2020-02-26","2021-04-28","2021-02-15","2021-03-12","2020-12-28","2021-11-03","2021-02-17","2021-02-17","2021-11-03","2021-02-21","2020-03-12","2021-11-15","2021-04-28","2021-07-13","2021-10-11","2020-03-12","2021-10-11","2021-05-06","2020-09-28","2021-09-16","2020-11-13","2021-05-06","2021-02-15","2021-02-15","2020-02-24","2020-02-24","2020-02-24","2021-03-10","2021-02-19","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2020-09-28","2021-03-15","2021-11-03","2020-11-13","2021-10-11","2021-11-15","2021-10-11","2021-11-15","2021-11-15"],"priorHcc":["","","","",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":[["","059746038606","TERAZOSIN ","10MG","90","Select","Select",""],["","068382031601","MINOCYCLINE ","50MG","-90","Select","Select",""],["","068180051703","LISINOPRIL ","40MG","90","Select","Select",""],["","070377000315","SIMVASTATIN ","20MG","90","Select","Select",""],["","065862014990","FINASTERIDE ","5MG","90","Select","Select",""],["","070710120901","ALLOPURINOL ","100MG","90","Select","Select",""],["","068180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","055111015810","OMEPRAZOLE ","20MG","90","Select","Select",""],["","068180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","000378020810","FUROSEMIDE ","20MG","-90","Select","Select",""],["","045802046564","KETOCONAZOLE ","2%","240","Select","Select",""],["","000093005805","TRAMADOL ","50MG","15","Select","Select",""],["","68382031601","","50MG","-90","Select","Select",""],["","59746038606","TERAZOSIN","10MG","90","Select","Select",""],["","68382031601","MINOCYCLINE","50MG","90","Select","Select",""],["","68180051703","LISINOPRIL","40MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","70710120901","ALLOPURINOL","100MG","90","Select","Select",""],["","65862014990","FINASTERIDE","5MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","90","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","90","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","30","Select","Select",""],["","00093005805","TRAMADOL","50MG","-12","Select","Select",""],["","53489011802","DOXYCYCL","50MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","240","Select","Select",""],["","70461012103","FLUAD","2021-22","0","Select","Select",""],["","53489011802","DOXYCYCL ","CAP 50MG","90","Select","Select",""],["","70461012103","FLUAD ","INJ 2021-22","0","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","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}