{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RACHEL   R TAYLOR","gend":1,"add":"600 WARWICK AVE APT L1","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1963-01-21","age":"","mstatus":"","insh":"900040201*01","cliId":"7MU5ND1YQ66","pno":"757\/738-0511","cno":"757\/738-0511","email":"","ename":"","eno":"","pphy":"FRIAS, ANGELINA MD","ppno":"757\/583-2181","pcpadd":"2203 E LITTLE CREEK RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":122721,"pcpname":"Roosevelt Family Practice","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/480-6482","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.909","R06.02","J33.9","G47.33","R06.83","J30.81","J30.1","J30.89","I10.","F32.9","F41.9","E78.5","E55.9","M54.42","D17.79","M47.816","Z98.1","M79.2","M62.838","M79.18","E66.01","M70.61","G89.29","N89.8","Z12.31","J30.9","R09.82","J45.40","J32.9","Z91.013","J01.90","J30.2","M53.3","M70.62","R05.","R06.2","M47.26","Z01.419","M25.531","M25.532","M65.4","M15.9","J45.20","J45.30","R76.8","R01.1","G47.30","G47.10","R35.1","M54.5","S79.911A","S89.92XA","S70.01XA","S80.212A","W19.XXXA","S99.912A","M79.641","M79.642","M18.11","M18.12","Z23.","R73.01","R30.0","Z68.41","Z88.5","Z88.8","Z91.048","Z79.899","Z83.3","Z82.49","Z83.1","Z84.1","M79.89","J34.2","J34.3","M51.37","Z20.822","Z20.828","Z79.51","M70.60","K62.5","K57.90","R10.30","R42.","R19.7","Z12.11","Z92.29"],"date":["2021-03-25","2020-10-30","2021-09-02","2021-10-05","2021-01-18","2021-08-19","2021-11-24","2021-08-19","2021-10-06","2021-10-05","2021-10-06","2021-10-06","2021-10-05","2021-10-05","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2020-10-07","2021-10-12","2021-11-24","2021-11-11","2021-11-11","2021-10-05","2021-07-15","2020-12-08","2021-08-19","2021-03-25","2021-03-25","2020-09-22","2020-09-22","2020-09-25","2020-10-07","2021-03-16","2021-03-16","2020-10-08","2020-10-08","2021-08-19","2021-10-05","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-10","2021-02-10","2021-03-16","2021-03-16","2021-03-12","2021-10-06","2020-09-22","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-03-25","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2020-10-26","2020-10-26","2020-11-11","2021-01-07","2021-01-07","2021-03-25","2021-03-25","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-05-23","2021-11-11"],"priorHcc":["","",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":[["","45802010401","OLOPATADINE","SPR 0.006","30","Select","Select",""],["","0","COMPOUND"," ","600","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","591352530","LIDOCAINE","PAD 0.05","60","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","-60","Select","Select",""],["","68180015301","DESLORATADIN","TAB 5MG","90","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","-21","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","-90","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","65162062710","TRAMADOL HCL","TAB 50MG","14","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","150","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","60505082701","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","0","","","-600","Select","Select",""],["","186037020","SYMBICORT ","","10","Select","Select",""],["","76204020025","ALBUTEROL SULFATE","","75","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","591352530","LIDOCAINE ","","30","Select","Select",""],["","67877019905","AMLODIPINE BESYLATE","","90","Select","Select",""],["","60505082701","IPRATROPIUM BROMIDE","","15","Select","Select",""],["","65162067684","AZELASTINE HYDROCHLORIDE","","-90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM ","","90","Select","Select",""],["","65862019105","CYCLOBENZAPRINE HYDROCHLORIDE","","60","Select","Select",""],["","68180015301","DESLORATADINE ","","90","Select","Select",""],["","45802010401","OLOPATADINE HCL ","","30","Select","Select",""],["","68180015301","DESLORATADINE","","90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","","90","Select","Select",""],["","45802010401","OLOPATADINE HCL","","30","Select","Select",""],["","45802006535","TRIAMCINOLONE ACETONIDE","0.50%","30","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","49502050002","EPIPEN 2-PAK","0.3MG","-2","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1%","100","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","160-4.5","31","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","HFA","18","Select","Select",""],["","58160088752","FLUARIX QUADRIVALENT 2021-2022","2021-22","0","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","-1","Select","Select",""],["","0","                                                                      "," ","600","Select","Select",""],["","50228018005","GABAPENTIN                                                            ","CAP 300MG","150","Select","Select",""],["","69097012303","TOPIRAMATE                                                            ","TAB 50MG","-60","Select","Select",""],["","00591352530","LIDOCAINE                                                             ","PAD 0.05","60","Select","Select",""],["","60505082701","IPRATROPIUM BROMIDE                                                   ","SPR 0.0006","15","Select","Select",""],["","65862057490","MONTELUKAST SODIUM                                                    ","TAB 10MG","90","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE                                                   ","TAB 25MG","90","Select","Select",""],["","00186037020","SYMBICORT                                                             ","AER 160-4.5","-10","Select","Select",""],["","76204020025","ALBUTEROL SULFATE                                                     ","NEB 0.00083","75","Select","Select",""],["","59746017306","PREDNISONE                                                            ","TAB 10MG","-21","Select","Select",""],["","65162067684","AZELASTINE HYDROCHLORIDE                                              ","SPR 0.001","90","Select","Select",""],["","65862019105","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 10MG","60","Select","Select",""],["","68180015301","DESLORATADINE                                                         ","TAB 5MG","-90","Select","Select",""],["","67877019905","AMLODIPINE BESYLATE                                                   ","TAB 10MG","90","Select","Select",""],["","65162062710","TRAMADOL HCL                                                          ","TAB 50MG","14","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","GEL 0.01","100","Select","Select",""],["","00093598627","EPINEPHRINE                                                           ","INJ 0.3MG","2","Select","Select",""],["","45802006535","TRIAMCINOLONE ACETONIDE                                               ","CRE 0.005","30","Select","Select",""],["","49502050002","EPIPEN 2-PAK                                                          ","INJ 0.3MG","2","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE                              ","AER 160-4.5","31","Select","Select",""],["","58160088752","FLUARIX QUADRIVALENT 2021-2022                                        ","INJ 2021-22","0","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","18","Select","Select",""],["","45802010401","OLOPATADINE HCL                                                       ","SPR 0.006","30","Select","Select",""],["","80777027398","MODERNA COVID-19 VACCINE                                              ","INJ COVID-19","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":[[["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":""}]}]}