{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON   R ROGERS","gend":1,"add":"914 SMOKETREE LN","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1953-12-03","age":"","mstatus":"","insh":"900045818*01","cliId":"8QU9K51FP45","pno":"757\/202-7145","cno":"757\/202-7145","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","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":["J45.909","G47.30","E11.9","I10.","E78.00","Z86.39","K59.00","R21.","F25.9","E66.01","G47.33","Z68.42","Z99.81","Z99.89","E66.2","M79.671","M79.672","I87.2","E11.40","L60.0","B35.1","M10.9","E11.69","Z12.11","M79.674","M79.675","Z12.31"],"date":["2021-01-26","2021-01-26","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-07-29","2021-03-30","2021-03-30","2021-03-30","2021-06-04","2021-03-25","2021-03-25","2021-07-06","2021-07-06","2021-03-25","2021-07-06","2021-03-25","2021-07-13","2021-05-23","2021-07-06","2021-07-06","2021-08-18"],"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":[["","62175011843","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","-90","Select","Select",""],["","72140000021","EUCERIN","CRE ","454","Select","Select",""],["","904759080","FEROSUL","TAB 325MG","180","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","200","Select","Select",""],["","43547034150","RISPERIDONE","TAB 1MG","90","Select","Select",""],["","904645760","DOK","CAP 100MG","90","Select","Select",""],["","363056314","ASPIRIN LOW","TAB 81MG EC","100","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","1530","Select","Select",""],["","54429731","FUROSEMIDE","TAB 20MG","180","Select","Select",""],["","55111053405","DIVALPROEX","TAB 500MG ER","90","Select","Select",""],["","31722088490","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","90","Select","Select",""],["","55111053405","DIVALPROEX SODIUM ER ","","90","Select","Select",""],["","904759080","FEROSUL ","","180","Select","Select",""],["","53885024510","ONETOUCH ULTRA","","200","Select","Select",""],["","53885039310","ONETOUCH ULTRASOFT LANCETS","","200","Select","Select",""],["","904645760","DOK ","","90","Select","Select",""],["","31722088490","ROSUVASTATIN CALCIUM ","","90","Select","Select",""],["","45802086803","POLYETHYLENE GLYCOL 3350","","1530","Select","Select",""],["","72140000021","EUCERIN ","","454","Select","Select",""],["","59651036205","IBUPROFEN ","","90","Select","Select",""],["","363056314","ASPIRIN LOW DOSE","","100","Select","Select",""],["","55111053405","DIVALPROEX SODIUM ER","","90","Select","Select",""],["","31722088490","ROSUVASTATIN CALCIUM","","90","Select","Select",""],["","53885013610","ONETOUCH DELICA LANCETS EXTRA FINE 33G","","200","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G","PLUS 33G","200","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":""}]}]}