{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA   F WEST","gend":1,"add":"2421 E PRINCESS ANNE ROAD APT C","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1957-07-24","age":"","mstatus":"","insh":"900042704*01","cliId":"9U90XP7JG13","pno":"757\/351-0297","cno":"757\/351-0297","email":"","ename":"","eno":"","pphy":"NEWBY-GOODMAN, MARCIA MD","ppno":"757\/942-8020","pcpadd":"930 MAJESTIC AVE STE 220","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":100347,"pcpname":"Primary Care Specialists","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/942-8015","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","Z68.42","Z12.31","N95.0","F17.200","Z00.00","Z13.31","Z91.81","N84.0","F17.210","Z79.899","Z88.0","R93.89","Z01.812","Z09.","Z20.822","Z01.818","R82.90","M25.561","M25.562","E66.01","E46.","Z71.3","N80.0","D27.1","K66.0","Z98.51","G47.30","K21.9","G43.909","Z78.0","M19.90","Z98.890","Z68.41","K59.03","R12.","Z90.722","M17.0","E87.6","Z71.89","Z23.","N73.6"],"date":["2021-09-08","2021-08-16","2021-08-16","2021-08-17","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2021-05-21","2021-08-12","2021-08-12","2021-08-12","2021-05-21","2021-08-10","2021-09-01","2021-08-10","2021-08-10","2021-08-10","2021-07-14","2021-07-14","2021-08-12","2021-07-14","2021-07-14","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-09-08","2021-08-16","2021-08-16","2021-08-16","2021-07-14","2021-08-09","2021-08-09","2021-10-06","2021-08-12"],"priorHcc":[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":[["","904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","31604003175",""," ","60","Select","Select",""],["","254100752","ALBUTEROL SULFATE HFA","","7","Select","Select",""],["","904759080","FEROSUL ","","60","Select","Select",""],["","68645056354","IBUPROFEN ","","30","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN","","15","Select","Select",""],["","00245010810","FERROUS SULFATE","","60","Select","Select",""],["","62332008090","VALSARTAN\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","00085113204","PROVENTIL HFA","","7","Select","Select",""],["","55111064530","OMEPRAZOLE","40MG","30","Select","Select",""],["","00832532411","POTASSIUM CHLORIDE ER","10MEQ ER","30","Select","Select",""],["","00182109301","SENNA-GEN","8.6MG","30","Select","Select",""],["","31604002612","IRON","325MG","180","Select","Select",""],["","49035036030","EQ SENNA-S","8.6-50MG","30","Select","Select",""],["","68645056354","IBUPROFEN                                                             ","TAB 800MG","-30","Select","Select",""],["","00254100752","ALBUTEROL SULFATE HFA                                                 ","AER HFA","7","Select","Select",""],["","00904759080","FEROSUL                                                               ","TAB 325MG","60","Select","Select",""],["","31604003175","                                                                      "," ","60","Select","Select",""],["","00245010810","FERROUS SULFATE                                                       ","TAB 325MG EC","60","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 5-325MG","15","Select","Select",""],["","00182109301","SENNA-GEN                                                             ","TAB 8.6MG","30","Select","Select",""],["","62332008090","VALSARTAN\/HYDROCHLOROTHIAZIDE                                         ","TAB 160-12.5","90","Select","Select",""],["","00832532411","POTASSIUM CHLORIDE ER                                                 ","TAB 10MEQ ER","30","Select","Select",""],["","00085113204","PROVENTIL HFA                                                         ","AER HFA","7","Select","Select",""],["","55111064530","OMEPRAZOLE                                                            ","CAP 40MG","-30","Select","Select",""],["","31604002612","IRON                                                                  ","TAB 325MG","180","Select","Select",""],["","49035036030","EQ SENNA-S                                                            ","TAB 8.6-50MG","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":[[["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":""}]}]}