{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" BRANSON E POWELL JR","gend":0,"add":"8701 OLD OCEAN VIEW ROAD","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1952-09-10","age":"","mstatus":"","insh":"900040218*01","cliId":"","pno":"757\/816-9373","cno":"757\/816-9373, ","email":"","ename":"","eno":"","pphy":"PAVON, HUMBERTO F MD","ppno":"757\/502-4840","pcpadd":"SUITE 101 5700 LAKE WRIGHT DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":141130,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","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":["R10.13","K76.0","R94.5","K81.0","K85.90","R17.","R78.81","A41.9","R07.89","E11.9","E78.5","I10.","K21.9","K85.10","Z01.818","Z68.31","R07.9","I25.10","R94.39","I25.110","Z95.1","N20.0","N40.1","N13.8","J84.10","Z98.61","Z00.00","Z23.","B34.9","R79.89","R68.89","R65.20","I21.4","B96.20","R93.1","E11.42","G47.33","Z87.891","I44.4","E78.00","I25.2","Z79.02","Z79.4","Z79.82","Z82.49","Z48.812","Z79.899","H33.302","K80.20","N28.1","E80.7","Z68.33","J90.","I30.9","K81.9","K83.09","R77.8","Z68.30","H43.813","H26.491","I11.9","Z79.84","R91.8","Z98.890","M10.9","E66.9","D18.00","L81.4","D22.9","Z85.828","N39.0","R50.9","K80.64","Z86.73","B96.89","I65.23"],"date":["2020-10-30","2020-10-30","2020-11-03","2020-10-30","2020-10-30","2020-10-30","2020-11-03","2020-11-03","2020-11-12","2021-04-13","2021-04-13","2021-04-13","2020-10-31","2020-11-11","2020-12-30","2020-12-02","2020-12-18","2021-02-10","2020-12-18","2021-01-04","2021-04-13","2021-06-21","2021-06-21","2021-06-21","2020-12-30","2021-01-05","2021-04-13","2020-10-07","2020-10-29","2020-11-02","2020-11-02","2020-11-02","2020-10-30","2020-11-03","2020-11-17","2021-02-10","2021-02-10","2021-04-02","2021-01-04","2021-02-10","2021-02-10","2021-01-04","2021-04-13","2021-04-02","2021-01-04","2021-04-02","2021-04-02","2020-09-21","2021-02-10","2020-10-30","2020-10-31","2020-11-04","2021-01-08","2020-10-30","2020-11-09","2020-11-09","2020-11-03","2020-11-12","2020-11-23","2020-11-23","2020-12-18","2021-02-10","2021-01-04","2021-01-04","2021-02-10","2021-02-10","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2020-10-30","2020-10-29","2020-10-30","2020-10-30","2020-10-30","2020-12-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00169255013","TRESIBA ","200UNIT","18","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","00597015390","JARDIANCE ","25MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","8","Select","Select",""],["","23155010210","METFORMIN ","500MG","360","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","180","Select","Select",""],["","70710121005","ALLOPURINOL ","300MG","90","Select","Select",""],["","00005197102","PREVNAR ","","0","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","100","Select","Select",""],["","65862073260","AMIODARONE ","200MG","20","Select","Select",""],["","00093727010","PRAVASTATIN ","80MG","26","Select","Select",""],["","62037099901","POT  CL MICRO","20MEQ ER","30","Select","Select",""],["","11917010657","MAG ","GRAPE","296","Select","Select",""],["","43598071901","CHLORTHALID ","25MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","28","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","-45","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","42543040801","POT  CITRATE ","1620MG","300","Select","Select",""],["","00363023820","STOOL ","100MG","60","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","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":""}]}]}