{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LILLIAN   R MAYO","gend":1,"add":"120 N CAPITAL ST","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1953-12-16","age":"","mstatus":"","insh":"900039828*01","cliId":"1CW3Y25RQ08","pno":"757\/354-6421","cno":"757\/354-6421","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","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":["M51.16","M17.11","M47.816","M54.41","E66.01","Z68.43","E11.9","I11.0","I50.9","Z85.42","Z90.710","Z79.82","Z79.899","Z79.1","Z79.84","Z88.8","Z88.2","M79.604","I42.9","I49.3","I11.9","E78.5","E11.69","S90.122A","M84.375G","R60.0","M79.672","Z01.812","Z20.828","Z12.11","K63.5","K57.30","M19.90","I25.10","Z68.42","Z83.71","H40.013","Z96.1","M43.6","I10.","R51.9","D57.3","Z88.5","M54.2","Z11.59","Z03.818","M21.6X2","M24.571","M84.375A","G57.52","G89.29","H04.123","J30.89","Z20.822","C54.1","N95.2","I70.0"],"date":["2020-08-24","2020-09-10","2020-09-10","2020-09-10","2021-05-23","2021-05-23","2021-05-23","2020-09-10","2020-11-19","2021-05-23","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2021-05-23","2021-05-23","2020-09-10","2021-05-23","2020-12-18","2020-12-18","2020-12-18","2021-01-12","2021-04-11","2021-08-04","2021-08-04","2021-08-04","2020-11-13","2020-11-13","2020-11-19","2020-11-19","2020-11-19","2021-05-23","2020-11-19","2020-11-19","2020-11-19","2021-10-12","2020-12-11","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2020-09-03","2020-09-03","2021-05-10","2021-05-10","2021-05-10","2021-08-04","2020-08-24","2021-10-12","2021-09-08","2021-09-08","2021-02-08","2021-02-08","2021-09-21"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","31722094101","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","5-325MG","20","Select","Select",""],["","43598071901","CHLORTHALIDONE","25MG","-90","Select","Select",""],["","52268001201","SUPREP BOWEL PREP KIT","PREP KIT","354","Select","Select",""],["","68382009205","CARVEDILOL","3.125MG","60","Select","Select",""],["","57237007710","ONDANSETRON ODT","4MG ODT","3","Select","Select",""],["","68645058459","METFORMIN HYDROCHLORIDE","1000MG","180","Select","Select",""],["","00173068220","VENTOLIN HFA","","-54","Select","Select",""],["","00406012301","HYDROCODONE\/ACETAMINOPHEN","5-325MG","20","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","90","Select","Select",""],["","68462019005","NAPROXEN","500MG","-20","Select","Select",""],["","68645051354","NIFEDIPINE ER","60MG ER","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","HFA","36","Select","Select",""],["","00172392670","DIAZEPAM","5MG","12","Select","Select",""],["","00140000514","VALIUM","5MG","12","Select","Select",""],["","52817019610","TRAMADOL HYDROCHLORIDE","100MG","-14","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20MG","90","Select","Select",""],["","69238149001","BUMETANIDE","1MG","30","Select","Select",""],["","69452014430","BENZONATATE","200MG","30","Select","Select",""],["","00406012301","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","20","Select","Select",""],["","43547040211","FUROSEMIDE                                                            ","TAB 40MG","90","Select","Select",""],["","75834010901","CHLORTHALIDONE                                                        ","TAB 25MG","90","Select","Select",""],["","68382009205","CARVEDILOL                                                            ","TAB 3.125MG","60","Select","Select",""],["","31722094101","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","20","Select","Select",""],["","52268001201","SUPREP BOWEL PREP KIT                                                 ","SOL PREP KIT","354","Select","Select",""],["","68645051354","NIFEDIPINE ER                                                         ","TAB 60MG ER","30","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","54","Select","Select",""],["","57237007710","ONDANSETRON ODT                                                       ","TAB 4MG ODT","3","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM                                                  ","TAB 20MG","90","Select","Select",""],["","68645058459","METFORMIN HYDROCHLORIDE                                               ","TAB 1000MG","-180","Select","Select",""],["","69238149001","BUMETANIDE                                                            ","TAB 1MG","30","Select","Select",""],["","68462019005","NAPROXEN                                                              ","TAB 500MG","20","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","54","Select","Select",""],["","00140000514","VALIUM                                                                ","TAB 5MG","12","Select","Select",""],["","00172392670","DIAZEPAM                                                              ","TAB 5MG","12","Select","Select",""],["","52817019610","TRAMADOL HYDROCHLORIDE                                                ","TAB 100MG","14","Select","Select",""],["","69452014430","BENZONATATE                                                           ","CAP 200MG","30","Select","Select",""],["","52817031910","BACLOFEN                                                              ","TAB 5MG","30","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":""}]}]}