{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   E MORRIS JOHNSON","gend":1,"add":"17258 DIANA CT","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1947-12-27","age":"","mstatus":"","insh":"900045236*01","cliId":"5YY9V32JQ29","pno":"804\/994-3488","cno":"804\/994-3488","email":"","ename":"","eno":"","pphy":"CROGNALE, ELIZABETH J MD","ppno":"804\/288-7901","pcpadd":"7702 E PARHAM RD #101","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23294,"pcpcounty":"","pcpid":111582,"pcpname":"Premier Health Care Associates","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/273-9167","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.909","D69.6","T88.7XXA","Z79.52","M32.9","Z71.9","G47.33","M35.1","Z01.419","G47.00","D69.3","R16.1","M81.0","I49.3","E11.29","E11.42","I10.","Z00.00","Z86.010","D12.7","Z01.812","D17.24","Z20.822","Z48.3","D17.79","Z87.891","Z79.899","R22.40","M79.7","M17.0","K21.9","J45.30","E11.9","H40.053","Z01.818","R22.42","K31.84","E78.2","E04.9"],"date":["2021-06-22","2021-08-17","2021-08-17","2021-08-17","2021-10-12","2021-06-22","2021-03-02","2021-01-13","2021-03-22","2021-03-22","2021-10-12","2021-04-20","2021-08-30","2021-01-13","2021-06-29","2021-11-02","2021-10-12","2021-07-19","2021-08-09","2021-08-09","2021-10-15","2021-11-01","2021-10-15","2021-11-01","2021-10-19","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-10-12","2021-10-26","2021-10-12","2021-10-12","2021-10-12","2021-11-02","2021-11-02"],"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]}},{"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":[["","43598072101","HYDROXYCHLOR ","200MG","60","Select","Select",""],["","59746017509","PREDNISONE ","20MG","45","Select","Select",""],["","57237001930","DULOXETINE ","60MG","30","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","90","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","60","Select","Select",""],["","31722070090","LOSARTAN ","25MG","90","Select","Select",""],["","00093505998","ATORVASTATIN ","20MG","90","Select","Select",""],["","00093220301","METOCLOPRAM ","10MG","90","Select","Select",""],["","55111064530","OMEPRAZOLE ","40MG","90","Select","Select",""],["","68645058259","METFORMIN ","500MG","360","Select","Select",""],["","00591090030","GLIPIZIDE ","2.5MG","90","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","053885059501","ONETOUCH ","30G","150","Select","Select",""],["","052268020101","SUTAB ","","24","Select","Select",""],["","43598072101","","200MG","90","Select","Select",""],["","43598072101","HYDROXYCHLOR","200MG","60","Select","Select",""],["","57237001930","DULOXETINE","60MG","30","Select","Select",""],["","00591090030","GLIPIZIDE","2.5MG","90","Select","Select",""],["","59746017509","PREDNISONE","20MG","45","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","60","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","68645058259","METFORMIN","500MG","-360","Select","Select",""],["","31722070090","LOSARTAN","25MG","-90","Select","Select",""],["","00093220301","METOCLOPRAM","10MG","90","Select","Select",""],["","55111064530","OMEPRAZOLE","40MG","90","Select","Select",""],["","68645051554","AMLODIPINE","5MG","30","Select","Select",""],["","00093505998","ATORVASTATIN","20MG","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","53885059501","ONETOUCH","30G","100","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","49281012165","FLUZONE","2021-22","1","Select","Select",""],["","50111056001","TRAZODONE","50MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","1","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":""}]}]}