{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONNIE   E GRANT","gend":0,"add":"2304 SPRUCE ST APT B","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1951-08-04","age":"","mstatus":"","insh":"900039717*01","cliId":"3NM5UF0GU63","pno":"757\/752-5692","cno":"757\/752-5692","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":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","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":["F20.9","Z76.89","R63.1","R73.03","R32.","R76.8","H54.3","Z72.0","Z12.5","Z68.1","I63.312","I66.02","I10.","G81.91","I63.512","J96.00","R13.10","R47.01","F33.8","Z46.59","I63.9","N40.0","F03.90","S09.90XA","S19.9XXA","S59.911A","S69.91XA","F17.200","J96.01","I16.1","S42.201A","N39.0","E78.00","E78.5","F32.9","F25.9","J44.9","R33.8","N40.1","R29.721","Z78.1","J69.0","K59.00","R39.81","L22.","N32.81","N41.8","I11.0","I50.9","E44.1","F41.9","M19.90","H40.9","H54.8","F17.210","Z91.81","S42.351A","S29.9XXA","S42.351D","I69.391","B96.4","T17.900A","R41.82","I69.318","G93.40","R41.0","R52.","Z74.3","S42.291A","Z79.899","Z88.0","J96.90","R63.8","Z93.1","D72.829","F33.9","E63.9","S42.301A","I69.320","R13.19","R53.1","R26.9","Z78.9","U07.1","E46.","M62.81","R13.12","K21.9","I69.351","M25.521","S59.901A","S49.91XA","R29.818","R07.9","I69.359","I69.891","R42.","Z86.718","T14.8XXA","Z46.82","Z20.828","R09.81","W19.XXXA","A41.9","R65.21","R33.9","J98.11","K82.8","K62.89","E27.8","K82.0","R05.","J98.4","R50.9","J18.9","E87.2","R78.81","R93.89","R53.81","Z71.89","Z51.5","E44.0","B96.20","L89.90","L98.499","R62.7","A41.51","T17.590A","J98.19","E87.0","N17.9","M62.82","M25.551","J98.2","J44.0","Z86.16","D64.9","F17.218","K64.0","I25.10","Z86.79","Z98.0","Z74.1","R63.4","E83.52","K29.60","L97.929","R69.","R54.","Z74.01","E55.9","E03.9","E21.3","R74.8","I95.9","R79.89","R10.11","R45.1","R74.01"],"date":["2020-10-12","2020-09-02","2020-09-02","2020-09-02","2020-10-12","2020-09-02","2020-10-12","2020-11-29","2020-09-02","2021-06-21","2020-11-30","2020-11-29","2021-11-18","2021-01-06","2021-05-06","2021-09-22","2021-06-25","2020-12-06","2020-12-30","2020-12-28","2021-05-06","2021-08-03","2021-11-18","2020-11-06","2020-11-06","2020-11-06","2020-11-06","2020-11-29","2021-06-21","2020-11-29","2020-12-18","2021-06-29","2020-11-29","2021-09-22","2020-11-29","2021-05-06","2021-08-24","2020-11-29","2021-06-23","2020-11-29","2020-11-29","2021-06-21","2021-08-26","2020-10-23","2020-10-23","2020-10-23","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2021-05-06","2020-10-16","2021-05-06","2021-06-21","2020-11-29","2020-10-16","2020-11-06","2020-11-06","2020-12-17","2021-06-21","2020-12-21","2020-12-21","2020-12-28","2021-01-06","2021-01-07","2021-01-12","2021-10-06","2020-11-29","2020-11-06","2020-11-29","2020-11-29","2020-12-03","2020-12-11","2021-02-25","2021-06-24","2021-08-25","2021-08-25","2021-01-10","2020-12-27","2020-12-29","2021-06-21","2021-01-06","2021-01-06","2021-05-06","2021-11-18","2021-10-04","2021-05-06","2021-10-06","2021-05-06","2020-11-06","2020-11-06","2020-11-06","2020-11-30","2021-06-23","2020-12-23","2021-01-20","2020-09-11","2020-12-30","2021-02-08","2020-11-30","2021-03-16","2020-10-12","2020-11-06","2021-11-24","2021-11-24","2021-11-16","2021-07-02","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-25","2021-06-23","2021-06-29","2021-07-01","2021-07-01","2021-06-24","2021-06-24","2021-06-29","2021-06-29","2021-07-02","2021-04-13","2021-03-11","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-20","2021-06-25","2021-08-17","2021-08-17","2021-09-13","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-07-09","2021-11-16","2021-09-09","2021-04-13","2021-04-23","2021-06-21","2021-06-21","2021-06-21","2021-08-25","2021-08-25","2021-09-24","2021-09-08","2021-11-09","2021-09-23","2021-09-14","2021-11-18","2021-09-09"],"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]}},{"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":[["","31722052590","FINASTERIDE","TAB 5MG","30","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","13668008190","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","57237007730","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","60505267109","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","10702018901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","13107004401","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","11534016503","FOLIC ACID","TAB 1MG","60","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","14","Select","Select",""],["","54629005701","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE","","90","Select","Select",""],["","57237023305","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","14","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","","28","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","","30","Select","Select",""],["","13107004401","OXYCODONE\/ACETAMINOPHEN","","12","Select","Select",""],["","57237007730","ONDANSETRON ODT ","","12","Select","Select",""],["","10702018901","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","","30","Select","Select",""],["","13668008190","MONTELUKAST SODIUM ","","24","Select","Select",""],["","60505267109","ATORVASTATIN CALCIUM ","","24","Select","Select",""],["","57237007730","ONDANSETRON ODT","","12","Select","Select",""],["","13668008190","MONTELUKAST SODIUM","","24","Select","Select",""],["","60505267109","ATORVASTATIN CALCIUM","","24","Select","Select",""],["","00378967130","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE","ALBUTER","90","Select","Select",""],["","58980078021","VENELEX","","60","Select","Select",""],["","00093681673","BUDESONIDE","0.5MG\/2","30","Select","Select",""],["","31722072320","LEVOFLOXACIN","750MG","3","Select","Select",""],["","00173087410","ARNUITY ELLIPTA","100MCG","-30","Select","Select",""],["","69097041002","CINACALCET HYDROCHLORIDE","30MG","60","Select","Select",""],["","00186091706","PULMICORT FLEXHALER","90MCG","1","Select","Select",""],["","00121086816","NYSTATIN","100000","473","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE                                              ","CAP 40MG","90","Select","Select",""],["","31722052590","FINASTERIDE                                                           ","TAB 5MG","30","Select","Select",""],["","57237023305","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","TAB 800-160","14","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","TAB 5MG","30","Select","Select",""],["","54629005701","VITAMIN B-1                                                           ","TAB 100MG","30","Select","Select",""],["","11534016503","FOLIC ACID                                                            ","TAB 1MG","60","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE                                                   ","CAP 100MG","28","Select","Select",""],["","13107004401","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 5-325MG","12","Select","Select",""],["","10702018901","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","30","Select","Select",""],["","60505267109","ATORVASTATIN CALCIUM                                                  ","TAB 80MG","30","Select","Select",""],["","57237007730","ONDANSETRON ODT                                                       ","TAB 4MG ODT","12","Select","Select",""],["","13668008190","MONTELUKAST SODIUM                                                    ","TAB 10MG","30","Select","Select",""],["","58980078021","VENELEX                                                               ","OIN ","57","Select","Select",""],["","31722072320","LEVOFLOXACIN                                                          ","TAB 750MG","3","Select","Select",""],["","00093681673","BUDESONIDE                                                            ","SUS 0.5MG\/2","30","Select","Select",""],["","00186091706","PULMICORT FLEXHALER                                                   ","INH 90MCG","1","Select","Select",""],["","69097041002","CINACALCET HYDROCHLORIDE                                              ","TAB 30MG","60","Select","Select",""],["","00378967130","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE                                 ","SOL ALBUTER","90","Select","Select",""],["","00121086816","NYSTATIN                                                              ","SUS 100000","473","Select","Select",""],["","59651024701","MIDODRINE HYDROCHLORIDE                                               ","TAB 5MG","180","Select","Select",""],["","08290306546","NORMAL SALINE FLUSH                                                   ","INJ 0.009","300","Select","Select",""],["","69315090405","LORAZEPAM                                                             ","TAB 0.5MG","-30","Select","Select",""],["","00173087410","ARNUITY ELLIPTA                                                       ","INH 100MCG","-30","Select","Select",""],["","00338130141","CEFEPIME                                                              ","INJ 1GM","450","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":""}]}]}