{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   F PRICE","gend":0,"add":"1008 DUNBAR ST","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1955-05-08","age":"","mstatus":"","insh":"900039178*01","cliId":"1KR1PT2YE25","pno":"757\/623-5560","cno":"757\/623-5560","email":"","ename":"","eno":"","pphy":"NEWBY, JAMES E MD","ppno":"757\/627-6892","pcpadd":"STE 220 930 MAJESTIC AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":100347,"pcpname":"Primary Care Specialists","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"757\/412-7170","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/627-5809","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.11","M25.461","M25.561","M16.12","M25.562","M25.552","G89.29","R22.42","E11.65","Z12.11","E11.9","I10.","Z68.41","D17.24","H60.502","T16.2XXA","E11.51","B35.1","L84.","M21.611","M21.612","L85.3","Z68.38","E66.01","Z88.8","Z79.84","Z79.899","Z79.1","Z87.891","D17.20","D17.22","H93.12","L29.8","H93.19","Z12.5","M17.12","Z68.39","Z01.818","Z20.828","K59.00","H53.021","M22.40","M54.2","M54.5","S61.217A","S50.01XA","W26.9XXA","Y93.9","Y92.9","Z86.010","K57.30","K64.1","H25.813"],"date":["2021-02-08","2021-02-08","2021-03-01","2020-05-11","2020-06-15","2020-05-15","2020-05-11","2020-11-23","2020-07-17","2021-05-23","2021-11-01","2021-08-09","2021-02-22","2020-12-10","2021-02-22","2021-02-23","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-08-10","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-09-04","2020-12-04","2021-02-23","2021-02-23","2021-02-23","2021-08-09","2020-05-15","2021-03-01","2020-12-01","2020-12-01","2020-12-10","2020-10-02","2020-07-10","2021-03-01","2021-03-01","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-09-20","2021-09-20","2021-09-20","2021-11-01"],"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":[["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","67877041301","METFORMIN ","500MG ER","30","Select","Select",""],["","33342007410","VALSART\/HCTZ ","80-12.5","30","Select","Select",""],["","45802041926","AMMONIUM ","12%","-400","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","20","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","90","Select","Select",""],["","00005197102","PREVNAR ","","0","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","38396031702","RELION ","THIN PLS","100","Select","Select",""],["","00904672040","ACETAMIN ","500MG","60","Select","Select",""],["","42858000101","OXYCODONE ","5MG","-30","Select","Select",""],["","45802086803","POLYETH ","3350 NF","510","Select","Select",""],["","78742026480","","","100","Select","Select",""],["","57896092101","ASPIRIN ","325MG EC","60","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","69097052444","DICLOFENAC ","1%","-300","Select","Select",""],["","52268020101","SUTAB ","","24","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","DIPROP","135","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","33342007410","VALSART\/HCTZ","80-12.5","30","Select","Select",""],["","68645056354","IBUPROFEN","800MG","20","Select","Select",""],["","67877041301","METFORMIN","500MG ER","30","Select","Select",""],["","68645051554","AMLODIPINE","5MG","90","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","10135068312","POLYETH","3350 NF","510","Select","Select",""],["","42858000101","OXYCODONE","5MG","30","Select","Select",""],["","00904672040","ACETAMIN","500MG","60","Select","Select",""],["","38396031702","RELION","THIN PLS","-100","Select","Select",""],["","57896092101","ASPIRIN","325MG EC","60","Select","Select",""],["","69097052444","DICLOFENAC","1%","-300","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","45802041926","AMMONIUM","12%","400","Select","Select",""],["","68462029855","CLOTRIM\/BETA","DIPROP","-135","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}