{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALONZO CALTON","gend":0,"add":"118 SOURWOOD DR","city":"DUFFIELD","state":"VA","zip":24244,"dob":"1950-08-14","age":"","mstatus":"","insh":"900044579*01","cliId":"","pno":"276\/431-1171","cno":"276\/431-1171    ","email":"","ename":"","eno":"","pphy":"WINEGAR, J BRYSTON MD","ppno":"276\/431-2648","pcpadd":"121 ADVANCED TECHNOLOGY DR","pcpcity":"DUFFIELD","pcpstate":"VA","pcpzip":24244,"pcpcounty":"","pcpid":123215,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Southwest Virginia","aligned":"Y","ano":"276\/431-1171, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I13.0","I50.9","E11.22","N18.4","D63.1","E11.51","I87.2","J44.9","I25.10","I25.5","I25.2","I48.91","E11.42","I70.0","M15.0","M81.0","N40.1","I12.9","N18.30","I87.323","E11.65","E11.8","B35.3","Z48.00","E11.628","Z79.4","Z79.899","I48.0","I10.","E66.01","Z68.41","N18.31","B35.1","M79.674","M79.675","I50.22","Z12.5","N28.1","R39.15"],"date":["2021-04-14","2021-04-14","2021-04-23","2021-04-14","2021-04-14","2021-04-14","2021-05-06","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-30","2021-03-04","2021-03-04","2021-05-06","2021-04-23","2021-03-24","2021-05-06","2021-03-25","2021-05-06","2021-05-06","2021-03-31","2021-03-31","2021-03-31","2021-05-06","2021-05-06","2021-04-23","2021-05-19","2021-05-19","2021-05-19","2021-01-25","2021-04-30","2021-04-30","2021-04-30"],"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":[["","456120130","LINZESS","CAP 145MCG","-90","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","180","Select","Select",""],["","169406012","VICTOZA","INJ 18MG\/3ML","18","Select","Select",""],["","169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","180","Select","Select",""],["","8290320119","BD PEN NEEDL","MIS 31GX5MM","200","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","300","Select","Select",""],["","13668010601","ISOSORB MONO","TAB 120MG ER","90","Select","Select",""],["","55111012405","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","169255013","TRESIBA FLEX","INJ 200UNIT","9","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","24576105","SOLIQUA","INJ 100\/33","-15","Select","Select",""],["","406012305","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","65862073260","AMIODARONE","TAB 200MG","30","Select","Select",""],["","54429931","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","69238183407","LEVOTHYROXIN","TAB 100MCG","30","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","360","Select","Select",""],["","378456105","POT CHLORIDE","TAB 10MEQ ER","45","Select","Select",""],["","363041414","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","1","Select","Select",""],["","904759080","FEROSUL","TAB 325MG","180","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","300","Select","Select",""],["","169406013","VICTOZA ","","-9","Select","Select",""],["","169643810","LEVEMIR FLEXTOUCH","","15","Select","Select",""],["","13668010601","ISOSORBIDE MONONITRATE ER ","","90","Select","Select",""],["","65862073260","AMIODARONE HYDROCHLORIDE","","30","Select","Select",""],["","65702071210","ACCU-CHEK GUIDE ","","300","Select","Select",""],["","8290320119","BD PEN NEEDLE\/MINI\/ULTRA-FINE\/31G X 5MM ","","200","Select","Select",""],["","68382013201","TAMSULOSIN HYDROCHLORIDE","","30","Select","Select",""],["","53746051105","SPIRONOLACTONE","","90","Select","Select",""],["","45963070911","METOPROLOL SUCCINATE ER","","180","Select","Select",""],["","169633910","NOVOLOG FLEXPEN ","","15","Select","Select",""],["","456120130","LINZESS ","","90","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN","","15","Select","Select",""],["","55111012405","ATORVASTATIN CALCIUM ","","48","Select","Select",""],["","904759080","FEROSUL ","","180","Select","Select",""],["","378456105","POTASSIUM CHLORIDE ER","","45","Select","Select",""],["","50924097110","ACCU-CHEK SOFTCLIX LANCETS","","300","Select","Select",""],["","24576105","SOLIQUA 100\/33","","15","Select","Select",""],["","69238183407","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","406012305","HYDROCODONE\/ACETAMINOPHEN ","","28","Select","Select",""],["","363041414","ASPIRIN ","","90","Select","Select",""],["","169255013","TRESIBA FLEXTOUCH","","9","Select","Select",""],["","57599000101","FREESTYLE LIBRE 14 DAY\/SENSOR\/FLASH MONITORING SYSTEM","","2","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM","","1","Select","Select",""],["","57629010020","FERROUS SULFATE ","","60","Select","Select",""],["","57237002801","AMOXICILLIN","","15","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}