{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALLIE   B BAKER","gend":1,"add":"902 MAGRUDER ROAD","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1929-06-02","age":"","mstatus":"","insh":"900039113*01","cliId":"3CM7GK9XA50","pno":"757\/477-8447","cno":"757\/477-8447","email":"","ename":"","eno":"","pphy":"ABU ABSI, MICHAEL S MD","ppno":"757\/539-0251","pcpadd":"2000 MEADE PKWY","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":122519,"pcpname":"Lakeview Internal Medicine Meade","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-9409","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R23.8","R60.9","E11.40","I10.","N18.30","E78.5","R53.83","R53.1","E03.9","E55.9","E11.9","Z23.","E11.51","L84.","L60.3","L60.0","Q82.0","I87.2","M62.81","M20.11","M20.12","M20.41","M20.42","R53.81","I63.9","N18.3","J44.9","N39.9","I12.9","E11.22","E11.42","D50.9","R60.0","N39.41","I48.0","I50.32","I27.20","R00.1","M70.62","Z51.81","Z79.899","D64.9","E11.65","R39.198","R41.82","F41.9","I48.91","R63.0","L97.522"],"date":["2020-07-08","2021-07-19","2021-02-04","2021-06-23","2021-02-22","2021-06-23","2021-02-04","2020-06-30","2020-10-09","2020-10-09","2021-06-23","2021-03-03","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-05-10","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-02-22","2020-10-21","2020-06-12","2020-10-21","2021-03-01","2021-02-22","2021-02-04","2021-06-23","2021-06-23","2021-02-22","2020-05-05","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-19","2021-02-04","2021-02-04","2021-02-04","2020-06-29","2020-06-29","2020-06-29","2021-06-23","2021-06-23","2021-06-23","2021-07-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","3089321","ELIQUIS","TAB 2.5MG","60","Select","Select",""],["","536100901","FERROUS SULF","TAB 325MG","180","Select","Select",""],["","597014030","TRADJENTA","TAB 5MG","30","Select","Select",""],["","228202950","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","23155000201","HYDRALAZINE","TAB 25MG","180","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","90","Select","Select",""],["","70436000203","POT CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","63044062201","RENO","CAP ","30","Select","Select",""],["","59779030602","CVS PURELAX","POW ","476","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","10","Select","Select",""],["","6011231","JANUVIA","TAB 50MG","30","Select","Select",""],["","65862073260","AMIODARONE","TAB 200MG","90","Select","Select",""],["","67877012450","SILVER SULFA","CRE 0.01","50","Select","Select",""],["","378180310","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","378932132","WIXELA INHUB","AER 250\/50","180","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","60","Select","Select",""],["","93742698","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","31722057330","ESOMEPRA MAG","CAP 40MG DR","90","Select","Select",""],["","63481068706","LIDODERM","DIS 0.05","30","Select","Select",""],["","603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","60258016201","RENAL","CAP ","30","Select","Select",""],["","27808008602","HYD POL\/CPM","SUS 10-8\/5ML","120","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","-14","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","18","Select","Select",""],["","6011231","JANUVIA ","","90","Select","Select",""],["","63044062201","RENO CAPS ","","90","Select","Select",""],["","536100901","FERROUS SULFATE ","","60","Select","Select",""],["","23155000201","HYDRALAZINE HYDROCHLORIDE ","","180","Select","Select",""],["","23155000101","HYDRALAZINE HCL ","","-120","Select","Select",""],["","378235193","ESOMEPRAZOLE MAGNESIUM","","-30","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","","90","Select","Select",""],["","27808008602","HYDROCODONE POLISTIREX\/CHLORPHENIRAMINE POLISTIREX","","120","Select","Select",""],["","378180310","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","93742698","MONTELUKAST SODIUM ","","30","Select","Select",""],["","70436000203","POTASSIUM CHLORIDE ER","","90","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS","","-100","Select","Select",""],["","53885065701","ONETOUCH VERIO","","1","Select","Select",""],["","597014030","TRADJENTA ","","30","Select","Select",""],["","65862073260","AMIODARONE HCL","","90","Select","Select",""],["","24658031205","DOXYCYCLINE HYCLATE","","14","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM ","","60","Select","Select",""],["","3089321","ELIQUIS ","","-60","Select","Select",""],["","57237001401","TAMSULOSIN HYDROCHLORIDE","","90","Select","Select",""],["","67877012450","SILVER SULFADIAZINE","","50","Select","Select",""],["","603188016","LIDOCAINE ","","30","Select","Select",""],["","65862073260","AMIODARONE HYDROCHLORIDE","","90","Select","Select",""],["","60258016201","RENAL CAPS","","30","Select","Select",""],["","23155000101","HYDRALAZINE HCL","","-120","Select","Select",""],["","00536100901","FERROUS SULFATE","","60","Select","Select",""],["","23155000201","HYDRALAZINE HYDROCHLORIDE","","180","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","","60","Select","Select",""],["","00093742698","MONTELUKAST SODIUM","","30","Select","Select",""],["","63044062201","RENO CAPS","","30","Select","Select",""],["","57664049983","MIRTAZAPINE","","30","Select","Select",""],["","45802004635","GENTAMICIN SULFATE","0.001","30","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","6","Select","Select",""],["","65862050220","AMOXICILLIN\/CLAVULANATE POTASSIUM","500-125","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}