{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANCES   D TAYLOR","gend":1,"add":"135 BRUNSWICK ROAD","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1938-03-18","age":"","mstatus":"","insh":"900039134*01","cliId":"5KM8UJ1NK26","pno":"434\/634-2329","cno":"434\/634-2329","email":"","ename":"","eno":"","pphy":"SQUIRE, ROBERT HALL MD","ppno":"434\/634-6101","pcpadd":"6 DOCTORS DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"pcpcounty":"","pcpid":104763,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/634-7117","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","S72.091A","S72.141A","Z03.818","N17.9","D62.","Z20.828","Z11.59","Z00.00","M81.0","Z13.6","K64.4","K57.30","Z90.710","K62.5","M25.551","W19.XXXA","Z98.890","S72.101D","Z47.89","N39.0","I15.9","R26.89","R27.8","R13.14","K40.90","K57.90","M25.559","S72.001D","S72.141D","M25.561","L60.1","M79.674","M79.675","M20.10","E55.9","S72.351A","K59.00","D64.9","M19.90","K64.9","Z88.0","Z91.81","Z79.82","R42.","W18.30XA","B95.2","I10.","D50.9","M48.54XA","Z04.89","R07.89","I16.0","E87.6","I50.32","S22.000A","I25.9","X58.XXXA","S30.0XXA","S39.92XA","E83.42","I11.0","I50.30","G89.29","R74.01","M54.5","Z01.818","M54.9","R79.89","R11.2","R10.13","K26.9","S22.050A","S22.060A","K29.80","M25.552","R11.0","R11.10","R53.1","J98.11","I51.7","R10.819","K22.2","K20.90","K29.50","K31.89","K29.90","E87.1","M80.08XA","M54.6","K31.1","K29.70","E86.0","K21.00","T39.395A","K76.0","Z98.41","M43.16","M43.06","R10.9","Z09.","R32.","R19.7","R09.02","K56.609","K41.30","K55.029","Z68.20","M15.0","K56.699","K40.30","K40.91","K21.9","K41.90","K46.0","Z46.82","R19.8","S22.050S","R68.89","K55.9","Z98.42","R41.0","K64.2","Z23.","Z79.899","Z20.822","Z87.11","Z87.440","I45.10","M19.91","D72.829","G25.81","K63.89","R03.0"],"date":["2021-09-01","2020-11-11","2020-12-01","2020-11-17","2021-04-02","2021-02-01","2021-02-22","2021-02-22","2020-08-24","2021-01-16","2020-08-24","2020-10-02","2021-06-29","2021-10-12","2020-10-02","2020-11-11","2021-05-25","2021-10-12","2021-02-01","2021-02-01","2021-06-29","2021-02-01","2021-02-01","2021-02-01","2021-04-02","2020-10-02","2020-10-02","2020-11-17","2021-01-16","2021-04-02","2020-12-29","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-05-24","2020-11-11","2021-10-12","2020-11-12","2021-10-12","2021-10-12","2021-05-25","2021-05-19","2021-10-12","2021-10-11","2020-11-11","2021-04-02","2021-10-21","2021-04-02","2021-07-16","2021-05-18","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2021-06-14","2021-05-18","2021-05-18","2021-05-25","2021-05-25","2021-07-02","2021-05-19","2021-05-19","2021-06-29","2021-05-19","2021-07-30","2021-07-12","2021-09-01","2021-05-19","2021-10-12","2021-07-01","2021-07-01","2021-07-16","2021-07-16","2021-07-02","2021-05-25","2021-06-03","2021-07-02","2021-10-14","2021-10-13","2021-06-29","2021-06-29","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-06-29","2021-07-02","2021-07-16","2021-07-26","2021-06-29","2021-07-01","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-10-12","2021-06-29","2021-06-29","2021-06-29","2021-07-30","2021-07-26","2021-08-10","2021-10-13","2021-10-25","2021-10-14","2021-10-14","2021-10-14","2021-04-02","2021-10-21","2021-10-13","2021-10-15","2021-10-21","2021-10-21","2021-10-13","2021-10-13","2021-10-13","2021-10-25","2021-10-25","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-13","2021-10-11"],"priorHcc":[null,"","","","","","","","","","","","",null,"","","",null,"","","","","","",null,"","","","","","","","","","","","",null,"",null,null,"","",null,null,"","",null,"","","","","","","","","","","","","","","","","","","",null,"",null,"","","","","","","","",null,null,"","","","","","","","","","","","","","","","",null,"","","","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","713050324","ANUCORT-HC","SUP 25MG","14","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","37864000051","SENNA","TAB 8.6MG","4","Select","Select",""],["","67877019710","AMLODIPINE","TAB 2.5MG","2","Select","Select",""],["","57896042110","STOOL SOFTNR","TAB 100MG","4","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","49035041412","ASPIRIN LOW","TAB 81MG EC","90","Select","Select",""],["","45802095301","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","406012301","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","143992701","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","0","Select","Select",""],["","49035050775",""," ","60","Select","Select",""],["","49348098115","SM ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","143992701","CIPROFLOXACIN HYDROCHLORIDE ","","14","Select","Select",""],["","70461012003","FLUAD QUADRIVALENT INFLUENZA VACCINE FOR ADULTS","","0","Select","Select",""],["","406012301","HYDROCODONE\/ACETAMINOPHEN ","","30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","","-100","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","","25","Select","Select",""],["","62175061746","PANTOPRAZOLE SODIUM","","16","Select","Select",""],["","67877019705","AMLODIPINE BESYLATE","","90","Select","Select",""],["","904628880","ASPIRIN LOW DOSE","","16","Select","Select",""],["","49035041412","EQ ASPIRIN ADULT LOW DOSE ","","90","Select","Select",""],["","59746012206","MECLIZINE HCL ","","30","Select","Select",""],["","49348098115","SM ASPIRIN ADULT LOW STRENGTH","","90","Select","Select",""],["","57896042110","STOOL SOFTENER","","32","Select","Select",""],["","57664037713","TRAMADOL HCL","","-30","Select","Select",""],["","60505082306","CALCITONIN-SALMON","","-4","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE ","","-30","Select","Select",""],["","43547026810","ROPINIROLE HYDROCHLORIDE","","30","Select","Select",""],["","49884016111","CALCITONIN SALMON","","4","Select","Select",""],["","00143992701","CIPROFLOXACIN HYDROCHLORIDE","","14","Select","Select",""],["","00406012301","HYDROCODONE\/ACETAMINOPHEN","","30","Select","Select",""],["","49035041412","EQ ASPIRIN ADULT LOW DOSE","","90","Select","Select",""],["","59746012206","MECLIZINE HCL","","30","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE","","30","Select","Select",""],["","00536120215","LIDOCAINE PAIN RELIEF PATCH","","60","Select","Select",""],["","60258017101","MAGNESIUM OXIDE","","30","Select","Select",""],["","67877021905","CEPHALEXIN","","20","Select","Select",""],["","42806054701","VITAMIN D","1.25MG","4","Select","Select",""],["","00143992701","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 250MG","14","Select","Select",""],["","00713050324","ANUCORT-HC                                                            ","SUP 25MG","14","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","GEL 0.01","-100","Select","Select",""],["","70461012003","FLUAD QUADRIVALENT INFLUENZA VACCINE FOR ADULTS                       ","INJ 0.5ML","0","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","25","Select","Select",""],["","00904628880","ASPIRIN LOW DOSE                                                      ","CHW 81MG","16","Select","Select",""],["","00406012301","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","30","Select","Select",""],["","49035050775","                                                                      "," ","60","Select","Select",""],["","62175061746","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","2","Select","Select",""],["","67877019705","AMLODIPINE BESYLATE                                                   ","TAB 2.5MG","90","Select","Select",""],["","49035041412","EQ ASPIRIN ADULT LOW DOSE                                             ","TAB 81MG EC","90","Select","Select",""],["","57896042110","STOOL SOFTENER                                                        ","TAB 100MG","4","Select","Select",""],["","59746012206","MECLIZINE HCL                                                         ","TAB 12.5MG","30","Select","Select",""],["","65162062750","TRAMADOL HCL                                                          ","TAB 50MG","30","Select","Select",""],["","60505082306","CALCITONIN-SALMON                                                     ","SPR 200\/ACT","-4","Select","Select",""],["","37864000051","SENNA                                                                 ","TAB 8.6MG","32","Select","Select",""],["","49348098115","SM ASPIRIN ADULT LOW STRENGTH                                         ","TAB 81MG EC","90","Select","Select",""],["","49884016111","CALCITONIN SALMON                                                     ","SPR 200\/ACT","4","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE                                             ","TAB 4MG","-30","Select","Select",""],["","67877021905","CEPHALEXIN                                                            ","CAP 500MG","20","Select","Select",""],["","60258017101","MAGNESIUM OXIDE                                                       ","TAB 400MG","30","Select","Select",""],["","00536120215","LIDOCAINE PAIN RELIEF PATCH                                           ","PAD 0.04","60","Select","Select",""],["","49035030603","EQ CLEARLAX                                                           ","POW ","510","Select","Select",""],["","62559015710","POLYETHYLENE GLYCOL 3350                                              ","POW 3350 NF","30","Select","Select",""],["","43547026810","ROPINIROLE HYDROCHLORIDE                                              ","TAB 0.25MG","30","Select","Select",""],["","42806054701","VITAMIN D                                                             ","CAP 1.25MG","4","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","",""],["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":""}]}]}