{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARON   L HOWARD","gend":0,"add":"1152 GLADIOLA CRES","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1986-09-27","age":"","mstatus":"","insh":"900042986*01","cliId":"1VC3KC4RP81","pno":"757\/301-3330","cno":"757\/301-3330","email":"","ename":"","eno":"","pphy":"BHATTACHARYYA, BISWA MD","ppno":"757\/275-9331","pcpadd":"2088 S INDEPENDENCE BLVD STE #103","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23453,"pcpcounty":"VIRGINIA BEACH CITY","pcpid":172075,"pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/416-7656","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","I31.3","M79.602","R00.2","E66.01","Z86.59","F17.210","E11.9","I10.","G47.30","Z88.8","R20.0","E55.9","E78.5","Z20.9","G47.33","G47.37","S39.94XA","K21.9","J30.1","E78.2","F20.9","N50.819","N40.1","F25.9","N13.8","H60.502","L30.9","M54.5","G89.29","Z68.43","R94.31"],"date":["2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-08-03","2021-02-25","2021-02-25","2021-08-03","2021-02-25","2021-07-27","2021-02-25","2021-02-25","2021-01-13","2021-01-13","2021-01-13","2021-11-16","2021-07-30","2021-06-17","2021-08-03","2021-06-17","2021-06-17","2021-06-17","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-11-12"],"priorHcc":["","","","","","","","","","","","","","","",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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","50111056001","TRAZODONE TAB ","50MG","60","Select","Select",""],["","55111025960","ZIPRASIDONE CAP ","80MG","60","Select","Select",""],["","185041005","BUPROPION TAB ","100MG SR","60","Select","Select",""],["","55111064530","OMEPRAZOLE CAP ","40MG","90","Select","Select",""],["","93720110","PRAVASTATIN TAB ","20MG","90","Select","Select",""],["","406012305","HYDROCO\/APAP TAB ","5-325MG","-8","Select","Select",""],["","66993068330","OLANZAPINE TAB ","10MG","30","Select","Select",""],["","406048410","APAP\/CODEINE TAB ","300-30MG","12","Select","Select",""],["","781261305","AMOXICILLIN CAP ","500MG","30","Select","Select",""],["","50458056401","INVEGA SUST ","INJ 234\/1.5","2","Select","Select",""],["","116200116","CHLORHEX GLU ","SOL 0.12%","473","Select","Select",""],["","80777027399","MODERNA VAC ","INJ COVID-19","0","Select","Select",""],["","29300022019","MONTELUKAST TAB ","10MG","90","Select","Select",""],["","68382013201","TAMSULOSIN CAP ","0.4MG","90","Select","Select",""],["","68645058259","METFORMIN TAB ","500MG","360","Select","Select",""],["","65162019011","NAPROXEN  ","TAB 500MG","20","Select","Select",""],["","51991096257","POLYETH GLYC ","POW 3350 NF","510","Select","Select",""],["","11523726803","MIRALAX  ","POW 3350 NF","10","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","60","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","93720110","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","2","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","60","Select","Select",""],["","66993068330","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","185061501","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","51991096257","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","-20","Select","Select",""],["","406048410","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","11523726803","MIRALAX","POW 3350 NF","10","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","360","Select","Select",""],["","68382013201","TAMSULOSIN HYDROCHLORIDE","","90","Select","Select",""],["","68645058259","METFORMIN HYDROCHLORIDE","","360","Select","Select",""],["","43598075205","BUPROPION HYDROCHLORIDE ER (SR) ","","30","Select","Select",""],["","55111025960","ZIPRASIDONE HCL ","","60","Select","Select",""],["","116200116","CHLORHEXIDINE GLUCONATE","","473","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE","","60","Select","Select",""],["","406048410","ACETAMINOPHEN\/CODEINE","","12","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","","10","Select","Select",""],["","51991096257","POLYETHYLENE GLYCOL 3350","","510","Select","Select",""],["","50458056401","INVEGA SUSTENNA ","","2","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE","","0","Select","Select",""],["","29300022019","MONTELUKAST SODIUM ","","90","Select","Select",""],["","406012305","HYDROCODONE\/ACETAMINOPHEN ","","-8","Select","Select",""],["","11523726803","MIRALAX ","","10","Select","Select",""],["","93720110","PRAVASTATIN SODIUM ","","90","Select","Select",""],["","185061501","HYDROXYZINE PAMOATE","","30","Select","Select",""],["","00591354005","BUPROPION HYDROCHLORIDE ER (SR)","","60","Select","Select",""],["","50458056401","INVEGA SUSTENNA","","2","Select","Select",""],["","55111025960","ZIPRASIDONE HCL","","60","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN","","-8","Select","Select",""],["","00093720110","PRAVASTATIN SODIUM","","90","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","","90","Select","Select",""],["","16714083801","ZIPRASIDONE HYDROCHLORIDE","","60","Select","Select",""],["","68645056354","IBUPROFEN","800MG","60","Select","Select",""],["","61314064610","NEOMYCIN\/POLYMYXIN\/HYDROCORTISONE","1% OTIC","10","Select","Select",""],["","37000045504","PRILOSEC OTC","20MG","90","Select","Select",""],["","69238153203","CLOBETASOL PROPIONATE","0.05%","30","Select","Select",""],["","55111064530","OMEPRAZOLE                                                            ","CAP 40MG","90","Select","Select",""],["","43598075205","BUPROPION HYDROCHLORIDE ER (SR)                                       ","TAB 150MG SR","30","Select","Select",""],["","55111025960","ZIPRASIDONE HCL                                                       ","CAP 80MG","60","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","60","Select","Select",""],["","50458056401","INVEGA SUSTENNA                                                       ","INJ 234\/1.5","2","Select","Select",""],["","66993068330","OLANZAPINE                                                            ","TAB 10MG","30","Select","Select",""],["","68645058259","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","360","Select","Select",""],["","00781261305","AMOXICILLIN                                                           ","CAP 500MG","30","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","8","Select","Select",""],["","65162019011","NAPROXEN                                                              ","TAB 500MG","-20","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","10","Select","Select",""],["","00406048410","ACETAMINOPHEN\/CODEINE                                                 ","TAB 300-30MG","12","Select","Select",""],["","00093720110","PRAVASTATIN SODIUM                                                    ","TAB 20MG","90","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE                                              ","INJ COVID-19","0","Select","Select",""],["","11523726803","MIRALAX                                                               ","POW 3350 NF","10","Select","Select",""],["","45802086866","POLYETHYLENE GLYCOL 3350                                              ","POW 3350 NF","28","Select","Select",""],["","68382013201","TAMSULOSIN HYDROCHLORIDE                                              ","CAP 0.4MG","90","Select","Select",""],["","00185061501","HYDROXYZINE PAMOATE                                                   ","CAP 50MG","30","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE                                               ","SOL 0.0012","473","Select","Select",""],["","31722072690","MONTELUKAST SODIUM                                                    ","TAB 10MG","90","Select","Select",""],["","37000045504","PRILOSEC OTC                                                          ","TAB 20MG","90","Select","Select",""],["","16714083801","ZIPRASIDONE HYDROCHLORIDE                                             ","CAP 80MG","60","Select","Select",""],["","69238153203","CLOBETASOL PROPIONATE                                                 ","CRE 0.0005","30","Select","Select",""],["","68645056354","IBUPROFEN                                                             ","TAB 800MG","60","Select","Select",""],["","61314064610","NEOMYCIN\/POLYMYXIN\/HYDROCORTISONE                                     ","SOL 1% OTIC","10","Select","Select",""],["","43547040111","FUROSEMIDE                                                            ","TAB 20MG","30","Select","Select",""],["","70010010810","GABAPENTIN                                                            ","CAP 100MG","90","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","",""],["No","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":""}]}]}