{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROL   A REITAN","gend":1,"add":"418 FLEMING CIR","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1952-08-30","age":"","mstatus":"","insh":"900044614*01","cliId":"7GP3DH6ET04","pno":"757\/405-4635","cno":"757\/405-4635","email":"","ename":"","eno":"","pphy":"BONEY, ARON R MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LANE SUITE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"NORFOLK CITY","pcpid":142722,"pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"Non-DSNP","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":["M79.601","S42.294A","I10.","J44.9","E11.40","E55.9","Z87.891","Z68.33","Z79.4","L28.0","D69.2","Z71.9","S42.294D","M54.6","E11.9","Z68.34","M54.12","F41.8","G47.00","B19.20","F17.210","Z91.81","M48.04","M51.14","M47.24","M25.511","Z68.32","M51.24","R20.0","R35.0","Z68.31","R61.","R20.2","Z12.2","F17.200","N95.9","Z12.11","J30.9","G89.29","Z51.81","J45.40","Z68.29","M85.852","M85.851","F41.9","R82.5","Z68.28","M85.80","K21.9","J98.8"],"date":["2021-02-01","2021-02-01","2021-09-22","2021-11-04","2021-09-22","2021-09-22","2021-09-22","2021-01-27","2021-01-27","2021-01-12","2021-01-12","2021-01-12","2021-06-09","2021-02-26","2021-03-02","2021-01-26","2021-02-12","2021-09-22","2021-09-22","2021-02-13","2021-06-17","2021-02-13","2021-02-19","2021-02-19","2021-02-19","2021-06-01","2021-03-02","2021-02-19","2021-02-19","2021-08-09","2021-05-19","2020-12-09","2020-12-02","2021-06-17","2021-08-09","2021-08-09","2021-09-22","2021-09-22","2021-08-09","2021-05-19","2021-07-01","2021-07-01","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-09-22","2021-09-22","2021-09-22","2021-09-16"],"priorHcc":["","",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":{"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":[["","68645055254","LISINOPRIL TAB ","10MG","90","Select","Select",""],["","70010010810","GABAPENTIN CAP ","100MG","90","Select","Select",""],["","55111018015","TIZANIDINE TAB ","4MG","120","Select","Select",""],["","42858000101","OXYCODONE TAB ","5MG","28","Select","Select",""],["","65702028810","FASTCLIX  ","MIS LANCETS","102","Select","Select",""],["","50924045001","ACCU-CHEK MIS ","MLTICLIX","-102","Select","Select",""],["","65162019011","NAPROXEN  ","TAB 500MG","60","Select","Select",""],["","29300022019","MONTELUKAST TAB ","10MG","90","Select","Select",""],["","574011830","TROSPIUM CHL ","CAP 60MG ER","30","Select","Select",""],["","173068220","VENTOLIN HFA ","AER","36","Select","Select",""],["","487950125","ALBUTEROL NEB ","0.083%","75","Select","Select",""],["","67877041301","METFORMIN TAB ","500MG ER","90","Select","Select",""],["","31722094201","HYDROCO\/APAP TAB ","7.5-325","-28","Select","Select",""],["","186037020","SYMBICORT AER ","160-4.5","10","Select","Select",""],["","781286810","OMEPRAZOLE CAP ","20MG","90","Select","Select",""],["","68645056259","IBUPROFEN TAB ","600MG","60","Select","Select",""],["","50111056001","TRAZODONE TAB ","50MG","90","Select","Select",""],["","53885024510","ONETOUCH  ","TES ULTRA","200","Select","Select",""],["","45802005536","TRIAMCINOLON OIN ","0.1%","80","Select","Select",""],["","54327099","FLUTICASONE SPR ","50MCG","32","Select","Select",""],["","68645052354","SERTRALINE TAB ","100MG","135","Select","Select",""],["","16729017117","AMITRIPTYLIN TAB ","10MG","90","Select","Select",""],["","310737020","BUDES\/FORMOT AER ","160-4.5","10","Select","Select",""],["","169633910","NOVOLOG  ","INJ FLEXPEN","15","Select","Select",""],["","50924045001","ACCU-CHEK","MIS MLTICLIX","102","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","-10","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","591363630","TROSPIUM CHL","CAP 60MG ER","-30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","28","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","36","Select","Select",""],["","168000680","TRIAMCINOLON","OIN 0.001","80","Select","Select",""],["","487950160","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","32","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","31722094201","HYDROCO\/APAP","TAB 7.5-325","28","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","135","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","60","Select","Select",""],["","781286810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","90","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","120","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","60","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","102","Select","Select",""],["","45802005536","TRIAMCINOLONE ACETONIDE","","80","Select","Select",""],["","487950160","ALBUTEROL SULFATE","","-75","Select","Select",""],["","42858000101","OXYCODONE HYDROCHLORIDE","","-28","Select","Select",""],["","31722094201","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","","-28","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","32","Select","Select",""],["","186037020","SYMBICORT ","","10","Select","Select",""],["","65702028810","ACCU-CHEK FASTCLIX LANCETS","","102","Select","Select",""],["","50924045001","ACCU-CHEK MULTICLIX LANCETS ","","102","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE","","120","Select","Select",""],["","68645052354","SERTRALINE HYDROCHLORIDE","","135","Select","Select",""],["","29300022019","MONTELUKAST SODIUM ","","90","Select","Select",""],["","67877041301","METFORMIN HYDROCHLORIDE ER","","90","Select","Select",""],["","591363630","TROSPIUM CHLORIDE ER ","","-30","Select","Select",""],["","310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","","-10","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE","","90","Select","Select",""],["","68645056259","IBUPROFEN ","","60","Select","Select",""],["","53885024510","ONETOUCH ULTRA","","200","Select","Select",""],["","169633910","NOVOLOG FLEXPEN ","","15","Select","Select",""],["","16729017117","AMITRIPTYLINE HYDROCHLORIDE ","","90","Select","Select",""],["","68645052154","SERTRALINE HCL","","7","Select","Select",""],["","62332002331","FLUOXETINE HCL","","60","Select","Select",""],["","42571012290","LEVOCETIRIZINE DIHYDROCHLORIDE","","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","","8","Select","Select",""],["","88221905","LANTUS SOLOSTAR ","","15","Select","Select",""],["","904576960","MAPAP ARTHRITIS PAIN ","","180","Select","Select",""],["","50924045001","ACCU-CHEK MULTICLIX LANCETS","","-102","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","","90","Select","Select",""],["","00591363630","TROSPIUM CHLORIDE ER","","-30","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","","15","Select","Select",""],["","16729017117","AMITRIPTYLINE HYDROCHLORIDE","","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","","15","Select","Select",""],["","00904576960","MAPAP ARTHRITIS PAIN","","180","Select","Select",""],["","00310461612","BREZTRI AEROSPHERE","","32","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM","READER","1","Select","Select",""],["","57599000101","FREESTYLE LIBRE 14 DAY\/SENSOR\/FLASH MONITORING SYSTEM","SENSOR","2","Select","Select",""],["","45802005536","TRIAMCINOLONE ACETONIDE                                               ","OIN 0.001","80","Select","Select",""],["","53885024510","ONETOUCH ULTRA                                                        ","TES ULTRA","200","Select","Select",""],["","00591363630","TROSPIUM CHLORIDE ER                                                  ","CAP 60MG ER","30","Select","Select",""],["","31722094201","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 7.5-325","28","Select","Select",""],["","42858000101","OXYCODONE HYDROCHLORIDE                                               ","TAB 5MG","28","Select","Select",""],["","00487950125","ALBUTEROL SULFATE                                                     ","NEB 0.00083","75","Select","Select",""],["","50924045001","ACCU-CHEK MULTICLIX LANCETS                                           ","MIS MLTICLIX","-102","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","32","Select","Select",""],["","65702028810","ACCU-CHEK FASTCLIX LANCETS                                            ","MIS LANCETS","102","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","90","Select","Select",""],["","00186037020","SYMBICORT                                                             ","AER 160-4.5","10","Select","Select",""],["","68645055254","LISINOPRIL                                                            ","TAB 10MG","90","Select","Select",""],["","65162019011","NAPROXEN                                                              ","TAB 500MG","60","Select","Select",""],["","70010010810","GABAPENTIN                                                            ","CAP 100MG","90","Select","Select",""],["","68645056259","IBUPROFEN                                                             ","TAB 600MG","60","Select","Select",""],["","67877041301","METFORMIN HYDROCHLORIDE ER                                            ","TAB 500MG ER","90","Select","Select",""],["","29300022019","MONTELUKAST SODIUM                                                    ","TAB 10MG","90","Select","Select",""],["","00781286810","OMEPRAZOLE                                                            ","CAP 20MG","90","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","-36","Select","Select",""],["","16729017117","AMITRIPTYLINE HYDROCHLORIDE                                           ","TAB 10MG","90","Select","Select",""],["","62332002331","FLUOXETINE HCL                                                        ","CAP 20MG","60","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE                              ","AER 160-4.5","10","Select","Select",""],["","31722055190","LEVOCETIRIZINE DIHYDROCHLORIDE                                        ","TAB 5MG","90","Select","Select",""],["","00904576960","MAPAP ARTHRITIS PAIN                                                  ","TAB 650MG","180","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","INJ 100\/ML","15","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN                                                       ","INJ FLEXPEN","15","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE                                              ","TAB 4MG","120","Select","Select",""],["","68645052154","SERTRALINE HCL                                                        ","TAB 25MG","7","Select","Select",""],["","68645052354","SERTRALINE HYDROCHLORIDE                                              ","TAB 100MG","135","Select","Select",""],["","00310461612","BREZTRI AEROSPHERE                                                    ","AER SPHERE","32","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","2","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":""}]}]}