{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL  M SMITHER","gend":0,"add":"5706 W FRANKLIN ST","city":"RICHMOND","state":"VA","zip":"23226-9998","dob":"1955-09-30","age":"","mstatus":"","insh":"900040450*01","cliId":"4XT9JE6GE46","pno":"239\/200-5544","cno":"239\/200-5544","email":"","ename":"","eno":"","pphy":"MIRSHAHI, IRAJ DO","ppno":"804\/673-2814","pcpadd":"5855 BREMO RD #102","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23226,"pcpcounty":"","pcpid":112694,"pcpname":"MONUMENT INTERNAL MEDICINE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/673-2873","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G62.9","R29.898","R25.3","G56.22","M79.605","M79.604","M96.1","M79.671","M79.672","F45.42","M54.9","I10.","E66.9","Z68.36","F17.210","Z79.1","M51.37","Z45.42","M43.16","M51.34","M51.36","Z68.35","M54.42","G89.29","H93.11","R73.03","G57.93","F32.9","F11.20","Z01.812","M54.5","M79.606","F17.200","Z12.11"],"date":["2020-11-17","2020-11-06","2020-11-06","2020-11-17","2021-08-18","2021-08-18","2021-08-18","2021-07-10","2021-07-10","2020-12-09","2021-05-10","2021-05-07","2021-05-07","2020-10-15","2021-05-03","2021-05-03","2020-10-20","2021-05-03","2021-02-17","2021-02-17","2021-02-17","2021-05-03","2021-05-07","2021-07-10","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-04-30","2021-08-18","2021-07-10","2021-07-10","2021-05-23"],"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":[["","13107008901","METHADONE","TAB 10MG","90","Select","Select",""],["","67877042905","GABAPENTIN","TAB 800MG","120","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","240","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","13107008901","METHADONE HCL ","","90","Select","Select",""],["","69097015815","MELOXICAM ","","60","Select","Select",""],["","31722094701","METHADONE HYDROCHLORIDE","","90","Select","Select",""],["","591352530","LIDOCAINE ","","30","Select","Select",""],["","55111018010","TIZANIDINE HYDROCHLORIDE","","240","Select","Select",""],["","13107008901","METHADONE HCL","","90","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE","10MG","10","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":""}]}]}