{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE  A BUSBY","gend":1,"add":"7938 OLD OCEAN VIEW AVE APT 101","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1968-03-17","age":"","mstatus":"","insh":"900040229*01","cliId":"4RW6U95GQ68","pno":"757\/267-0987","cno":"757\/267-0987","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J31.0","G50.1","J30.9","R09.81","H92.02","K13.70","Z72.0","R49.0","R04.2","K13.21","F31.62","F90.1","F41.1","F33.2","F90.0","R13.10","K13.79"],"date":["2021-01-20","2021-01-20","2021-01-20","2020-11-25","2020-09-11","2020-09-11","2021-05-13","2020-10-22","2020-10-22","2020-10-22","2021-07-08","2021-07-08","2021-03-08","2021-04-15","2020-09-24","2021-05-13","2021-05-13"],"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":[["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","55111078430","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","32","Select","Select",""],["","603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","527150637","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","65862037505","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","57896070310","IRON","TAB 325MG","30","Select","Select",""],["","16714062202","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","31722054501","LITHIUM CARB","CAP 300MG","180","Select","Select",""],["","59148003813","REXULTI","TAB 2MG","30","Select","Select",""],["","93317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","63481068706","LIDODERM","DIS 0.05","30","Select","Select",""],["","69315090501","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE","","90","Select","Select",""],["","29300012510","MELOXICAM ","","30","Select","Select",""],["","16714062202","ZOLPIDEM TARTRATE","","30","Select","Select",""],["","31722054501","LITHIUM CARBONATE","","180","Select","Select",""],["","597007541","SPIRIVA HANDIHALER ","","30","Select","Select",""],["","59148003813","REXULTI ","","30","Select","Select",""],["","16714080801","AMPHETAMINE\/DEXTROAMPHETAMINE","","60","Select","Select",""],["","65862037505","ESCITALOPRAM OXALATE ","","30","Select","Select",""],["","603188016","LIDOCAINE ","","30","Select","Select",""],["","93317431","ALBUTEROL SULFATE HFA","","8","Select","Select",""],["","31722072610","MONTELUKAST SODIUM ","","30","Select","Select",""],["","55111078430","FEXOFENADINE HYDROCHLORIDE","","30","Select","Select",""],["","60505083305","AZELASTINE HYDROCHLORIDE","","30","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","32","Select","Select",""],["","69315090501","LORAZEPAM ","","60","Select","Select",""],["","68462053253","CLOBETASOL PROPIONATE","","100","Select","Select",""],["","71930004512","OXYCODONE\/ACETAMINOPHEN","","5","Select","Select",""],["","121086816","NYSTATIN","","360","Select","Select",""],["","65862037505","ESCITALOPRAM OXALATE","","30","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","","30","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","","30","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE","COVID-19","0","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","40","Select","Select",""],["","65862039010","ONDANSETRON ODT","4MG ODT","20","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":""}]}]}