{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARL   R HALL","gend":0,"add":"15395 MOORES MILL ROAD","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1953-04-09","age":"","mstatus":"","insh":"900042963*01","cliId":"9QT0FR5UF17","pno":"301\/395-5222","cno":"301\/395-5222","email":"","ename":"","eno":"","pphy":"HUOT, RACHEL MD","ppno":"804\/632-1030","pcpadd":"102 W BROADDUS AVE SUITE 200","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":209163,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/632-1033","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z01.812","Z20.822","Z12.11","E11.9","I10.","E78.2","E03.9","H25.011","M25.511","Z71.89","Z71.3","E66.3","G43.A0","N52.9","Z96.0","H25.9","Z79.4","E78.5","E11.42","Z02.83","H61.22","F98.0","M54.2","R51.9","T50.B95A","D64.9","Z12.5","M25.512","J30.9","L98.491","E66.9","N39.3","Z85.46","K21.9","I73.9","I25.2","I25.10","N17.9","M19.90","F12.90","Z79.899","Z87.11"],"date":["2021-03-02","2021-03-01","2021-03-01","2021-03-05","2021-04-13","2021-09-08","2021-09-03","2021-09-08","2021-03-08","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-01-15","2021-01-15","2021-01-15","2021-09-03","2021-04-13","2021-09-08","2021-09-08","2021-09-03","2021-06-04","2021-06-04","2021-09-03","2021-06-08","2021-06-08","2021-09-08","2021-09-08","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-09","2021-09-09","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05"],"priorHcc":["","","","","",null,null,null,"","","","","","","","",null,"",null,null,null,"","",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":[["","60505267108","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","88222033","LANTUS","INJ 100\/ML","-10","Select","Select",""],["","16729000316","GLIMEPIRIDE","TAB 4MG","30","Select","Select",""],["","69238183007","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","49483048112","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","597014860","JENTADUETO","TAB 2.5-1000","60","Select","Select",""],["","67877019710","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","65162062750","TRAMADOL HCL","TAB 50MG","60","Select","Select",""],["","66733077301","INSULIN LISP","INJ 100\/ML","-10","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","24","Select","Select",""],["","172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","10702019201","HYDROCO\/APAP","TAB 5-300MG","20","Select","Select",""],["","143924920","AMOX\/K CLAV","TAB 875-125","12","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","354","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","67877019710","AMLODIPINE BESYLATE","","30","Select","Select",""],["","69238183007","LEVOTHYROXINE SODIUM ","","30","Select","Select",""],["","60505267108","ATORVASTATIN CALCIUM ","","30","Select","Select",""],["","68645056259","IBUPROFEN ","","20","Select","Select",""],["","52268001201","SUPREP BOWEL PREP KIT","","354","Select","Select",""],["","49483048112","ASPIRIN LOW DOSE","","30","Select","Select",""],["","143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM ","","12","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","","20","Select","Select",""],["","66733077301","INSULIN LISPRO","","-10","Select","Select",""],["","406048410","ACETAMINOPHEN\/CODEINE","","10","Select","Select",""],["","69238183007","LEVOTHYROXINE SODIUM","","30","Select","Select",""],["","60505267108","ATORVASTATIN CALCIUM","","30","Select","Select",""],["","00143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM","","12","Select","Select",""],["","57599000101","FREESTYLE LIBRE 14 DAY\/SENSOR\/FLASH MONITORING SYSTEM","","6","Select","Select",""],["","10702000709","CYCLOBENZAPRINE HYDROCHLORIDE","","90","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM","","1","Select","Select",""],["","70010077001","METHOCARBAMOL","","20","Select","Select",""],["","08627005303","DEXCOM G6 SENSOR","SENSOR","3","Select","Select",""],["","08627001601","DEXCOM G6 TRANSMITTER","TRANSMIT","1","Select","Select",""],["","68180051202","LISINOPRIL","2.5MG","-30","Select","Select",""],["","08627009111","DEXCOM G6 RECEIVER","RECEIVER","1","Select","Select",""],["","08627001401","DEXCOM G5 MOBILE TRANSMITTER KIT","TRANSMIT","1","Select","Select",""],["","00088222033","LANTUS                                                                ","INJ 100\/ML","10","Select","Select",""],["","69238183007","LEVOTHYROXINE SODIUM                                                  ","TAB 25MCG","30","Select","Select",""],["","00597014860","JENTADUETO                                                            ","TAB 2.5-1000","60","Select","Select",""],["","49483048112","ASPIRIN LOW DOSE                                                      ","TAB 81MG EC","30","Select","Select",""],["","00172392670","DIAZEPAM                                                              ","TAB 5MG","2","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","20","Select","Select",""],["","16729000316","GLIMEPIRIDE                                                           ","TAB 4MG","30","Select","Select",""],["","67877019710","AMLODIPINE BESYLATE                                                   ","TAB 2.5MG","30","Select","Select",""],["","60505267108","ATORVASTATIN CALCIUM                                                  ","TAB 80MG","30","Select","Select",""],["","65162062750","TRAMADOL HCL                                                          ","TAB 50MG","60","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","-1","Select","Select",""],["","68645056259","IBUPROFEN                                                             ","TAB 600MG","20","Select","Select",""],["","00143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","TAB 875-125","12","Select","Select",""],["","66733077301","INSULIN LISPRO                                                        ","INJ 100\/ML","-10","Select","Select",""],["","52268001201","SUPREP BOWEL PREP KIT                                                 ","SOL PREP KIT","354","Select","Select",""],["","00781261305","AMOXICILLIN                                                           ","CAP 500MG","24","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM                 ","MIS READER","1","Select","Select",""],["","57599000101","FREESTYLE LIBRE 14 DAY\/SENSOR\/FLASH MONITORING SYSTEM                 ","KIT SENSOR","6","Select","Select",""],["","10702000709","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 10MG","90","Select","Select",""],["","70010077001","METHOCARBAMOL                                                         ","TAB 750MG","20","Select","Select",""],["","08627005303","DEXCOM G6 SENSOR                                                      ","MIS SENSOR","3","Select","Select",""],["","08627001601","DEXCOM G6 TRANSMITTER                                                 ","MIS TRANSMIT","1","Select","Select",""],["","08627009111","DEXCOM G6 RECEIVER                                                    ","MIS RECEIVER","1","Select","Select",""],["","00469260290","MYRBETRIQ                                                             ","TAB 50MG","30","Select","Select",""],["","68180051202","LISINOPRIL                                                            ","TAB 2.5MG","30","Select","Select",""],["","00406048410","ACETAMINOPHEN\/CODEINE                                                 ","TAB 300-30MG","10","Select","Select",""],["","08627001401","DEXCOM G5 MOBILE TRANSMITTER KIT                                      ","MIS TRANSMIT","1","Select","Select",""],["","67877022310","GABAPENTIN                                                            ","CAP 300MG","-60","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":""}]}]}