{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DORA   A CALTON","gend":1,"add":"118 SOURWOOD DR","city":"DUFFIELD","state":"VA","zip":"24244-9998","dob":"1954-07-31","age":"","mstatus":"","insh":"900045505*01","cliId":"8RK6FP8GC48","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","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/431-2082","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D69.6","D50.9","I20.9","M79.89","M65.342","Z13.820","Z00.00","D69.3","E66.01","J44.9","M50.30","E11.40","K74.60","D69.2","I89.0","I83.93","I10.","J01.90","R06.83","I83.893","E11.628","E66.9","R25.2","E11.9","Z68.33","Z79.84","Z68.35","R60.0","R21.","Z48.00","R52.","I87.2","K62.5","Z86.010","Z87.19","Z68.34","M10.9","K64.4"],"date":["2021-09-08","2021-01-26","2021-09-15","2021-06-15","2021-03-15","2021-03-15","2021-03-15","2021-09-15","2021-09-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-11-09","2021-06-29","2021-11-09","2021-06-15","2021-06-15","2021-11-09","2021-11-09","2021-11-09","2021-07-29","2021-10-07","2021-11-09","2021-11-09","2021-07-08","2021-10-07","2021-07-08","2021-09-09","2021-07-29","2021-11-08","2021-11-08","2021-10-26","2021-10-07","2021-10-07","2021-06-15","2021-10-26"],"priorHcc":[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":[["","64980027903","GLIPIZIDE ER","TAB 2.5MG","90","Select","Select",""],["","378668999","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","54429931","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","115166001","PROPRANOLOL","TAB 20MG","-60","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","59651006605","OLOPATADINE","SOL 0.002","2","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","100","Select","Select",""],["","31722088390","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","115166001","PROPRANOLOL HYDROCHLORIDE ","","60","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","68462034690","LEVOCETIRIZINE DIHYDROCHLORIDE","","90","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM ","","30","Select","Select",""],["","59651006605","OLOPATADINE HYDROCHLORIDE ","","2","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM ","","30","Select","Select",""],["","378668999","PANTOPRAZOLE SODIUM","","90","Select","Select",""],["","65702071210","ACCU-CHEK GUIDE ","","100","Select","Select",""],["","59651006605","OLOPATADINE HYDROCHLORIDE","","2","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","","30","Select","Select",""],["","00115166001","PROPRANOLOL HYDROCHLORIDE","","60","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","65702071210","ACCU-CHEK GUIDE","","100","Select","Select",""],["","68180016013","AZITHROMYCIN","","6","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE","","10","Select","Select",""],["","16729013516","ALLOPURINOL","","30","Select","Select",""],["","43598043611","NITROGLYCERIN","","-25","Select","Select",""],["","00378108601","COLCHICINE","","3","Select","Select",""],["","70461012103","FLUAD QUADRIVALENT 2021-2022","2021-22","0","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","HFA","8","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM                                                  ","TAB 50MCG","30","Select","Select",""],["","00054429931","FUROSEMIDE                                                            ","TAB 40MG","-60","Select","Select",""],["","59651006605","OLOPATADINE HYDROCHLORIDE                                             ","SOL 0.002","2","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","68462034690","LEVOCETIRIZINE DIHYDROCHLORIDE                                        ","TAB 5MG","90","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM                                                  ","TAB 10MG","30","Select","Select",""],["","00378668999","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","90","Select","Select",""],["","64980027903","GLIPIZIDE ER                                                          ","TAB 2.5MG","30","Select","Select",""],["","00115166001","PROPRANOLOL HYDROCHLORIDE                                             ","TAB 20MG","60","Select","Select",""],["","00378108601","COLCHICINE                                                            ","TAB 0.6MG","3","Select","Select",""],["","65702071210","ACCU-CHEK GUIDE                                                       ","TES GUIDE","100","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","10","Select","Select",""],["","16729013516","ALLOPURINOL                                                           ","TAB 300MG","90","Select","Select",""],["","70461012103","FLUAD QUADRIVALENT 2021-2022                                          ","INJ 2021-22","0","Select","Select",""],["","68180051303","LISINOPRIL                                                            ","TAB 5MG","30","Select","Select",""],["","43598043611","NITROGLYCERIN                                                         ","SUB 0.4MG","-25","Select","Select",""],["","68180016013","AZITHROMYCIN                                                          ","TAB 250MG","6","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA                                                 ","AER HFA","-8","Select","Select",""],["","10572010001","PEG-3350\/ELECTROLYTES                                                 ","SOL ELECTROL","4000","Select","Select",""],["","62559043130","HYDROCORTISONE                                                        ","CRE 0.025","30","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":""}]}]}