{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH   J ESPOSITO","gend":0,"add":"500 CHAPEL LAKE DR APT 101","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1954-03-05","age":"","mstatus":"","insh":"900038643*01","cliId":"1QE9JG2TR35","pno":"757\/754-3339","cno":"757\/754-3339","email":"","ename":"","eno":"","pphy":"THOMAS, BRANT MD","ppno":"757\/481-3770","pcpadd":"STE 4 1821 OLD DONATION PKY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":120796,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-4905","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M54.5","M79.661","R00.0","R53.1","M48.062","Z68.36","M79.662","Z68.37","M47.812","M43.13","M43.12","M99.71","M47.814","R20.0","N13.4","N20.0","K76.0","K80.20","K57.30","N17.9","I10.","R52.","Z20.828","Z12.5","Z00.00","Z12.11","Z71.89","R42.","M99.73","Z68.34","Z68.35","M25.512","M25.511","M25.542","M25.541","R68.84","M25.532","M25.531","Z96.643","Z96.0","F17.200","Z88.8","G47.00","D56.9","H25.812","H25.811","E66.09","G47.33","M16.12","N23.","N28.9","Z46.6","N20.1","I73.9","M51.86","M48.07","M48.061","M43.26","M79.604","M79.605","M25.50","M47.816","H25.813","N13.30","R10.9","M51.36","M43.16","N13.2","R31.9","H25.9","I47.1","R07.9","M54.42","M35.3","Z11.59","R53.83","R73.01","M79.10","R06.02"],"date":["2021-05-31","2021-05-31","2020-12-14","2021-06-01","2021-11-05","2021-11-05","2021-08-10","2021-03-08","2021-03-08","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2020-08-03","2020-09-29","2020-08-01","2020-08-01","2020-08-01","2020-08-02","2021-05-31","2020-08-02","2020-08-02","2020-11-05","2021-08-10","2021-05-23","2020-11-05","2020-11-05","2020-11-10","2020-04-30","2020-09-11","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-07-06","2021-05-31","2021-05-31","2021-05-31","2020-06-02","2020-06-02","2020-07-14","2020-07-28","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-03","2020-08-03","2020-09-28","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-10-20","2021-03-05","2020-06-19","2020-08-02","2020-08-02","2021-07-06","2020-11-11","2020-08-03","2020-08-17","2020-06-30","2021-06-13","2021-06-13","2021-07-06","2021-07-29","2021-07-22","2021-07-22","2021-07-13","2021-11-05","2021-11-14"],"priorHcc":["","","","",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":[["","65162062750","TRAMADOL ","50MG","60","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","20-12.5","90","Select","Select",""],["","55111018010","TIZANIDINE ","4MG","30","Select","Select",""],["","00527293341","PREDNISONE ","10MG","21","Select","Select",""],["","10370082909","DILTIAZEM ","120MG ER","-90","Select","Select",""],["","45802025735","MOMETASONE ","0.10%","45","Select","Select",""],["","51672129801","KETOCONAZOLE ","2%","45","Select","Select",""],["","59746000106","METHYLPRED ","4MG","25","Select","Select",""],["","62037059790","CARTIA ","120\/24HR","90","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","16714071302","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","57237007810","ONDANSETRON ","8MG ODT","15","Select","Select",""],["","61314035501","TROPICAMIDE ","1% OP","3","Select","Select",""],["","61314014305","BRIMONIDINE ","0.2% OP","5","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5","Select","Select",""],["","47335022090","KETOROLAC ","0.50%","5","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","30","Select","Select",""],["","62332054715","CLOBETASOL ","0.05%","60","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","-3","Select","Select",""],["","27241016701","DOXEPIN ","10MG","30","Select","Select",""],["","00093094801","DICLOFEN ","50MG","30","Select","Select",""],["","031722061190","PREGABALIN ","50MG","60","Select","Select",""],["","65162062750","","50MG","60","Select","Select",""],["","65162062750","TRAMADOL","50MG","60","Select","Select",""],["","68180051902","LISINOP\/HCTZ","20-12.5","-90","Select","Select",""],["","10370082909","DILTIAZEM","120MG ER","-90","Select","Select",""],["","59746000106","METHYLPRED","4MG","-25","Select","Select",""],["","00527293341","PREDNISONE","10MG","21","Select","Select",""],["","55111018010","TIZANIDINE","4MG","30","Select","Select",""],["","51672129801","KETOCONAZOLE","2%","45","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","15","Select","Select",""],["","16714071302","TAMSULOSIN","0.4MG","30","Select","Select",""],["","45802025735","MOMETASONE","0.10%","45","Select","Select",""],["","61314014305","BRIMONIDINE","0.2% OP","5","Select","Select",""],["","62037059790","CARTIA","120\/24HR","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","69097094312","GABAPENTIN","300MG","30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","-3","Select","Select",""],["","62332054715","CLOBETASOL","0.05%","60","Select","Select",""],["","27241016701","DOXEPIN","10MG","30","Select","Select",""],["","00093094801","DICLOFEN","50MG","30","Select","Select",""],["","31722061190","PREGABALIN","50MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","90","Select","Select",""],["","61314035501","TROPICAMIDE","1% OP","3","Select","Select",""],["","47335022090","KETOROLAC","0.50%","5","Select","Select",""],["","65862000899","METFORMIN ","TAB 500MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","68462011944","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","53885004601","ONETOUCH ","KIT ULTRA 2","1","Select","Select",""],["","56151088880","TRUETRACK ","KIT SYSTEM","1","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","-200","Select","Select",""],["","08496301001","EASY ","MIS LANC\/30G","100","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":""}]}]}