{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALMA   M DODSON","gend":1,"add":"2698 FLAT ROCK ROAD","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1948-05-16","age":"","mstatus":"","insh":"900038782*01","cliId":"4GY7HC0HY76","pno":"434\/292-3229","cno":"434\/292-3229","email":"","ename":"","eno":"","pphy":"CHEEMA, RAZA MD","ppno":"434\/767-5511","pcpadd":"412 NAMOZINE ST","pcpcity":"BURKEVILLE","pcpstate":"VA","pcpzip":23922,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/767-2659","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N64.89","M25.511","M54.2","D05.11","E55.9","M54.42","M25.674","M79.671","R26.81","I10.","E78.00","K21.9","M10.9","R73.01","E66.9","Z68.36","R68.83","G56.02","G89.18","Z90.11","J34.89","R09.81","Z20.828","L72.3","L76.34","M89.9","Z85.3","M25.611","R29.3","M62.81","R60.0","M25.539","Z11.59","G56.03","Z12.11","Z23.","M19.90","M54.5","Z68.35","Z91.81","J01.90","J30.9","G89.29","M54.50","L02.91"],"date":["2020-03-17","2020-06-09","2020-06-09","2021-09-22","2021-09-22","2020-07-27","2020-08-18","2020-08-18","2020-08-18","2021-10-27","2021-10-27","2021-10-27","2021-06-03","2020-08-13","2021-10-27","2020-08-13","2020-09-22","2021-01-19","2021-01-19","2021-03-31","2021-02-03","2021-02-03","2021-08-12","2021-10-27","2020-03-06","2020-03-06","2021-01-21","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-09-03","2020-09-29","2021-01-04","2021-05-23","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-07-12","2021-07-12","2021-10-27","2021-10-27","2021-10-27"],"priorHcc":["","","",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":[["","68382041205","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","527163210","TRIAMT\/HCTZ","CAP 37.5-25","90","Select","Select",""],["","378247401","DICLOFEN POT","TAB 50MG","90","Select","Select",""],["","13668008105","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","16729003515","ANASTROZOLE","TAB 1MG","90","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","12","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","93727098","PRAVASTATIN","TAB 80MG","90","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","90","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","57664037713","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","51660020005","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","29300034910","ALLOPURINOL","TAB 100MG","90","Select","Select",""],["","70000018002","8 HOUR PAIN","TAB 650MG","60","Select","Select",""],["","781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69097012715","AMLODIPINE BESYLATE","","90","Select","Select",""],["","29300022010","MONTELUKAST SODIUM ","","30","Select","Select",""],["","60505132309","PRAVASTATIN SODIUM ","","90","Select","Select",""],["","60505265605","TRIAMTERENE\/HYDROCHLOROTHIAZIDE ","","90","Select","Select",""],["","59746000103","METHYLPREDNISOLONE DOSE PACK","","21","Select","Select",""],["","61442010310","DICLOFENAC SODIUM DR ","","90","Select","Select",""],["","70000018002","8 HOUR ARTHRITIS PAIN RELIEVER","","60","Select","Select",""],["","51660020005","EZETIMIBE ","","90","Select","Select",""],["","378247401","DICLOFENAC POTASSIUM ","","90","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","16729011917","MONTELUKAST SODIUM","","30","Select","Select",""],["","61442010310","DICLOFENAC SODIUM DR","","90","Select","Select",""],["","60505132309","PRAVASTATIN SODIUM","","30","Select","Select",""],["","60505265605","TRIAMTERENE\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","00378247401","DICLOFENAC POTASSIUM","","90","Select","Select",""],["","00093227534","AMOXICILLIN\/CLAVULANATE POTASSIUM","875-125","14","Select","Select",""],["","49502010202","EPINEPHRINE                                                           ","INJ 0.3MG","2","Select","Select",""],["","16729011917","MONTELUKAST SODIUM                                                    ","TAB 10MG","30","Select","Select",""],["","61442010310","DICLOFENAC SODIUM DR                                                  ","TAB 75MG DR","90","Select","Select",""],["","68382041205","OMEPRAZOLE                                                            ","CAP 20MG","30","Select","Select",""],["","60505132309","PRAVASTATIN SODIUM                                                    ","TAB 80MG","30","Select","Select",""],["","57664037713","TRAMADOL HCL                                                          ","TAB 50MG","15","Select","Select",""],["","45802065087","LORATADINE                                                            ","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE DOSE PACK                                          ","TAB 4MG","21","Select","Select",""],["","75834002001","VITAMIN D3                                                            ","CAP 50000UNT","12","Select","Select",""],["","00781808926","AZITHROMYCIN                                                          ","TAB 250MG","6","Select","Select",""],["","16729003515","ANASTROZOLE                                                           ","TAB 1MG","90","Select","Select",""],["","68180051703","LISINOPRIL                                                            ","TAB 40MG","90","Select","Select",""],["","69097012715","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","60505265605","TRIAMTERENE\/HYDROCHLOROTHIAZIDE                                       ","TAB 37.5-25","90","Select","Select",""],["","67877022310","GABAPENTIN                                                            ","CAP 300MG","270","Select","Select",""],["","29300034910","ALLOPURINOL                                                           ","TAB 100MG","90","Select","Select",""],["","70000018002","8 HOUR ARTHRITIS PAIN RELIEVER                                        ","TAB 650MG","60","Select","Select",""],["","00093094801","DICLOFENAC POTASSIUM                                                  ","TAB 50MG","90","Select","Select",""],["","51660020005","EZETIMIBE                                                             ","TAB 10MG","90","Select","Select",""],["","67877021905","CEPHALEXIN                                                            ","CAP 500MG","40","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","00093227534","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","TAB 875-125","14","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":""}]}]}