{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHY SHAW","gend":1,"add":"401 ROBERTS AVE APT 504","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1960-06-16","age":"","mstatus":"","insh":"900039777*01","cliId":"4A15V68XC51","pno":"804\/720-5600","cno":"804\/720-5600","email":"","ename":"","eno":"","pphy":"QUARSHIE, GEORGE MD","ppno":"","pcpadd":"20901 CHESTERFIELD AVENUE","pcpcity":"SOUTH CHESTERFIELD","pcpstate":"VA","pcpzip":23803,"pcpcounty":"","pcpid":208807,"pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S63.502A","W19.XXXA","B35.3","B35.1","E11.59","L60.0","R42.","S09.90XA","M47.892","M50.321","M50.322","M50.323","M25.78","R07.9","I10.","J44.9","E78.5","E11.9","M54.9","G89.29","F17.210","Z04.3","M54.2","M79.602","W19.XXXD","M25.532","E11.65","Z68.24","Z79.4","E11.40","Z79.84","Z79.899","Z79.811","G45.9","S64.22XA","S13.9XXA","Z68.23","M25.562","M54.30","M11.262","K21.9","R26.9","M79.10","M62.830","M54.5","E78.2","Z87.19","H25.13"],"date":["2020-10-21","2020-10-21","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-12","2020-10-12","2020-10-12","2020-11-25","2020-11-25","2020-11-25","2020-11-25","2020-08-05","2021-07-27","2020-08-05","2021-05-24","2021-10-29","2020-08-05","2020-08-05","2021-05-24","2020-10-12","2020-11-25","2020-11-25","2020-11-25","2020-10-12","2020-12-17","2020-12-17","2021-07-27","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-10-14","2020-10-14","2020-10-14","2021-07-27","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-07-27","2021-07-27","2021-10-29"],"priorHcc":["","","","","","","","","","","","","","","","","",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":[["","88221905","LANTUS SOLOS","INJ 100\/ML","6","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","8290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","-100","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","30","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","-10","Select","Select",""],["","378395205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","93","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","88221905","LANTUS SOLOSTAR ","","6","Select","Select",""],["","186037020","SYMBICORT ","","-10","Select","Select",""],["","378395205","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","","10","Select","Select",""],["","8290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"","","100","Select","Select",""],["","53885024510","ONETOUCH ULTRA","","-100","Select","Select",""],["","53885013610","ONETOUCH DELICA LANCETS EXTRA FINE 33G","","100","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G ","","100","Select","Select",""],["","8290054701","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM","","10","Select","Select",""],["","591544305","PREDNISONE","","18","Select","Select",""],["","406051205","OXYCODONE\/ACETAMINOPHEN","","12","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","","-6","Select","Select",""],["","00378395205","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G","","100","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT","VERIO RE","1","Select","Select",""],["","00169185389","NOVOTWIST 32GX5MM","32GX5MM","-100","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS","VERIO","100","Select","Select",""],["","45802008801","ALBUTEROL SULFATE HFA                                                 ","AER HFA","-8","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE                              ","AER 160-4.5","10","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","INJ 100\/ML","-6","Select","Select",""],["","67877022305","GABAPENTIN                                                            ","CAP 300MG","93","Select","Select",""],["","65162062711","TRAMADOL HCL                                                          ","TAB 50MG","-30","Select","Select",""],["","00186037020","SYMBICORT                                                             ","AER 160-4.5","-10","Select","Select",""],["","53885024510","ONETOUCH ULTRA                                                        ","TES ULTRA","100","Select","Select",""],["","08290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"                                ","MIS 32GX5\/32","-100","Select","Select",""],["","00378395205","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G                           ","MIS PLUS 33G","100","Select","Select",""],["","53885013610","ONETOUCH DELICA LANCETS EXTRA FINE 33G                                ","MIS LANCETS","100","Select","Select",""],["","08290054701","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM                              ","MIS 32GX4MM","10","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS                                            ","TES VERIO","100","Select","Select",""],["","00406051205","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 5-325MG","12","Select","Select",""],["","00169185389","NOVOTWIST 32GX5MM                                                     ","MIS 32GX5MM","100","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT                                                ","KIT VERIO RE","1","Select","Select",""],["","00591544305","PREDNISONE                                                            ","TAB 20MG","18","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":""}]}]}