{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGE   W MCMILLIAN JR","gend":0,"add":"3727 TURNPIKE ROAD APT B","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1973-10-30","age":"","mstatus":"","insh":"900039532*01","cliId":"3MG5FG9UX62","pno":"757\/998-0256","cno":"757\/998-0256","email":"","ename":"","eno":"","pphy":"RAMSEY, KRISTIN DO","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":137859,"pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0007","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","F10.129","M62.82","F19.10","F10.920","Z79.899","Z87.891","R41.82","F10.10","R45.851","R74.8","K85.20","U07.1","F20.9","F90.2","E78.5","Z23.","Z13.31","F10.230","I51.7","E55.9","F10.229","J45.909","R07.9","Y90.9","R10.10","R10.84","Z20.828","R10.9","K86.0","F10.220","F32.9","D72.819","J45.20","F41.9","I10.","F14.10","F11.10","F17.200","F10.120","Z76.5","Y90.5","F20.0","F10.239","F33.1","Z59.0","Z91.19","E87.6","Z91.5","Z88.5","F11.90","R06.02","R11.0","Z76.0","K85.90","Z20.9","Y90.7","F20.5","F33.9","K86.1","F12.90","F14.90","F15.90","J44.9","Z56.0","F29.","K21.9","R19.6","Z12.11","B35.1","R42.","K42.9","Z68.30","Z79.51","F22.","Z83.3","Z86.59","J30.9","N42.9","K59.00","J32.9","H04.123","Z78.9","L60.3","A49.9","L60.8","L81.4","Z59.89","L84."],"date":["2020-06-22","2020-08-12","2020-06-22","2021-06-27","2020-06-26","2021-11-20","2021-11-20","2020-06-26","2021-02-18","2020-09-06","2020-06-27","2021-05-10","2020-09-06","2021-06-03","2020-09-27","2021-08-24","2020-10-09","2020-10-09","2020-08-25","2020-08-26","2021-08-24","2020-06-23","2021-11-20","2020-08-22","2020-08-12","2020-06-27","2020-08-22","2020-06-27","2021-01-19","2020-08-22","2020-07-17","2021-06-27","2020-07-17","2020-07-17","2021-08-24","2020-09-11","2020-07-17","2020-07-17","2020-07-17","2020-08-10","2020-08-14","2020-08-22","2020-08-22","2020-08-22","2020-08-22","2020-08-22","2020-08-22","2020-08-22","2020-08-22","2021-06-03","2020-06-30","2020-06-30","2020-07-11","2020-06-14","2020-07-17","2020-08-10","2020-06-30","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2021-03-16","2021-04-05","2021-03-16","2021-06-04","2021-06-27","2021-05-10","2021-05-10","2021-04-02","2021-06-03","2021-06-03","2021-06-03","2021-08-03","2021-06-25","2021-08-24","2021-03-12","2021-07-15","2021-06-25","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-20","2021-07-09"],"priorHcc":["","","","","",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":[["","186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","904549213","THERA-M","TAB ","30","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","29300024310","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","16714048203","LORATADINE","TAB 10MG","30","Select","Select",""],["","65862037301","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","36","Select","Select",""],["","51991064310","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","27241000550","RISPERIDONE","TAB 3MG","30","Select","Select",""],["","168009915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","5250033","FIBERCON","TAB 625MG","30","Select","Select",""],["","904645780","DOK","CAP 100MG","60","Select","Select",""],["","16714047801","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","29300024310","AMLODIPINE BESYLATE","","30","Select","Select",""],["","310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","","10","Select","Select",""],["","186037020","SYMBICORT ","","10","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","","30","Select","Select",""],["","16729017017","ESCITALOPRAM OXALATE ","","30","Select","Select",""],["","904549213","THERA-M ","","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","76204020060","ALBUTEROL SULFATE","","540","Select","Select",""],["","51672128402","TRIAMCINOLONE ACETONIDE","","60","Select","Select",""],["","904645780","DOK ","","60","Select","Select",""],["","16714047801","AMOXICILLIN\/CLAVULANATE POTASSIUM ","","14","Select","Select",""],["","69452015120","VITAMIN D ","","12","Select","Select",""],["","16729017017","ESCITALOPRAM OXALATE","","30","Select","Select",""],["","16714047801","AMOXICILLIN\/CLAVULANATE POTASSIUM","","14","Select","Select",""],["","00597016061","SPIRIVA RESPIMAT","1.25MCG","4","Select","Select",""],["","57896040110","DOCUSATE SODIUM","100MG","60","Select","Select",""],["","00186037020","SYMBICORT                                                             ","AER 160-4.5","10","Select","Select",""],["","27241000550","RISPERIDONE                                                           ","TAB 3MG","30","Select","Select",""],["","16729017017","ESCITALOPRAM OXALATE                                                  ","TAB 20MG","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","18","Select","Select",""],["","16714048203","LORATADINE                                                            ","TAB 10MG","30","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE                              ","AER 160-4.5","10","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","30","Select","Select",""],["","29300024210","AMLODIPINE BESYLATE                                                   ","TAB 5MG","30","Select","Select",""],["","51672128402","TRIAMCINOLONE ACETONIDE                                               ","OIN 0.001","60","Select","Select",""],["","76204020060","ALBUTEROL SULFATE                                                     ","NEB 0.00083","720","Select","Select",""],["","00168009915","KETOCONAZOLE                                                          ","CRE 0.02","15","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","12","Select","Select",""],["","00005250033","FIBERCON                                                              ","TAB 625MG","30","Select","Select",""],["","00904549213","THERA-M                                                               ","TAB ","30","Select","Select",""],["","16714047801","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","TAB 875-125","14","Select","Select",""],["","51991064310","OMEPRAZOLE                                                            ","CAP 20MG","30","Select","Select",""],["","00904645780","DOK                                                                   ","CAP 100MG","60","Select","Select",""],["","00597016061","SPIRIVA RESPIMAT                                                      ","AER 1.25MCG","4","Select","Select",""],["","57896040110","DOCUSATE SODIUM                                                       ","CAP 100MG","60","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":""}]}]}