{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PEGGY   E LIVERMAN","gend":1,"add":"322 BRUCE STREET APT B","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1968-06-05","age":"","mstatus":"","insh":"900046874*01","cliId":"5JW1QT7CX04","pno":"757\/907-3884","cno":"757\/907-3884","email":"","ename":"","eno":"","pphy":"MUGAISI, HESED N MD","ppno":"757\/738-1375","pcpadd":"148 BURNETTS WAY STE 107","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":207896,"pcpname":"BON SECOURS SUFFOLK PRIMARY CARE","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-6935","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z78.0","M85.89","N18.30","E78.5","E11.22","N18.32","Z79.4","I10.","D64.9","I50.32","I25.118","Z95.5","I11.0","G47.33","E66.01","Z68.42","Z12.31","E11.649","Z13.820","M81.0","R06.2","G47.36","E11.43","E78.2","E55.9","E66.9","M54.16","Z46.81","M79.672","L60.0","D47.2","D50.9","M51.37","M48.07","G89.4","Z12.11","H33.41","H44.522","D22.71","N18.6","R06.02","E87.70","E11.9","R13.19","J45.909","G47.30","Z23.","Z04.3","E11.3593","I50.21","E87.6","I50.9","I13.0","E11.40","J90.","M54.2","T14.90XA","R07.81","J96.01","J45.901","M25.571","R60.9","J45.21","J18.9","I50.42","J44.0","J44.1","Z20.822","D63.1","I25.10","K21.9","Z01.812","D48.9","S90.221A","D22.9","Z71.9","I50.33","I08.1","I25.2","Z87.01","Z79.899","Z79.82","Z79.51","Z79.02","R91.8","T14.8XXA","M79.661"],"date":["2021-04-19","2021-04-19","2021-10-22","2021-06-01","2021-10-22","2021-04-13","2021-07-15","2021-09-08","2021-10-27","2021-06-01","2021-06-01","2021-09-07","2021-06-01","2021-06-08","2021-10-22","2021-10-22","2021-04-19","2021-06-01","2021-04-19","2021-04-19","2021-05-17","2021-06-08","2021-08-17","2021-07-15","2021-07-15","2021-09-07","2021-07-08","2021-07-15","2021-07-16","2021-07-16","2021-08-27","2021-08-27","2021-07-08","2021-07-08","2021-07-08","2021-05-23","2021-07-30","2021-07-30","2021-08-20","2021-09-07","2021-10-22","2021-09-07","2021-09-07","2021-10-12","2021-10-12","2021-10-12","2021-10-27","2021-11-05","2021-08-18","2021-09-08","2021-09-08","2021-09-08","2021-10-22","2021-10-22","2021-10-21","2021-11-05","2021-11-05","2021-11-05","2021-10-27","2021-10-27","2021-11-05","2021-11-05","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-08","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-10-21","2021-11-05","2021-11-05"],"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,null,null,null,null,null,null,null,null,null,null,null,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":[["","63304082890","ATORVASTATIN ","20MG","28","Select","Select",""],["","13668010410","ISOSORB ","30MG ER","28","Select","Select",""],["","00832532410","POT  CL MICRO","10MEQ ER","56","Select","Select",""],["","43547034811","PAROXETINE ","20MG","28","Select","Select",""],["","00173072020","FLOVENT ","220MCG","12","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","57664037718","TRAMADOL ","50MG","42","Select","Select",""],["","00378668910","PANTOPRAZOLE ","40MG","28","Select","Select",""],["","31722070110","LOSARTAN ","50MG","56","Select","Select",""],["","16729013401","ALLOPURINOL ","100MG","28","Select","Select",""],["","00597014030","TRADJENTA ","5MG","28","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","28","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","60","Select","Select",""],["","68382009501","CARVEDILOL ","25MG","56","Select","Select",""],["","16729021816","CLOPIDOGREL ","75MG","28","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","28","Select","Select",""],["","50228042460","RANOLAZINE ","1000MG","56","Select","Select",""],["","31722052201","HYDRALAZINE ","100MG","84","Select","Select",""],["","00904323392","CALCIUM\/D ","600-400","60","Select","Select",""],["","68382091634","METHYLPRED ","4MG","-21","Select","Select",""],["","67877022201","GABAPENTIN ","100MG","-56","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","3","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","11917009215","FERROUS ","325MG","90","Select","Select",""],["","000002773701","INSULIN ","100\/ML","140","Select","Select",""],["","000093314705","CEPHALEXIN ","500MG","28","Select","Select",""],["","00193731221","CONTOUR ","NEXT","600","Select","Select",""],["","16729013401","","100MG","28","Select","Select",""],["","00173072020","FLOVENT","220MCG","12","Select","Select",""],["","63304082890","ATORVASTATIN","20MG","28","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","28","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","16729013401","ALLOPURINOL","100MG","28","Select","Select",""],["","68382009501","CARVEDILOL","25MG","56","Select","Select",""],["","67877022201","GABAPENTIN","100MG","56","Select","Select",""],["","00378668910","PANTOPRAZOLE","40MG","28","Select","Select",""],["","43547034811","PAROXETINE","20MG","28","Select","Select",""],["","69097012815","AMLODIPINE","10MG","28","Select","Select",""],["","50228042460","RANOLAZINE","1000MG","56","Select","Select",""],["","31722070110","LOSARTAN","50MG","56","Select","Select",""],["","00597014030","TRADJENTA","5MG","28","Select","Select",""],["","57664037718","TRAMADOL","50MG","42","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","84","Select","Select",""],["","16729021816","CLOPIDOGREL","75MG","28","Select","Select",""],["","31722052201","HYDRALAZINE","100MG","84","Select","Select",""],["","00904323392","CALCIUM\/D","600-400","60","Select","Select",""],["","68382091634","METHYLPRED","4MG","21","Select","Select",""],["","13668010410","ISOSORB","30MG ER","28","Select","Select",""],["","51862094205","DIAZEPAM","5MG","-3","Select","Select",""],["","00832532410","POT CL MICRO","10MEQ ER","56","Select","Select",""],["","11917009215","FERROUS","325MG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","28","Select","Select",""],["","00193737701","CONTOUR","NEXT","1","Select","Select",""],["","00002773701","INSULIN","100\/ML","10","Select","Select",""],["","00904759080","FEROSUL","325MG","90","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","1","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","90","Select","Select",""],["","80681016900","VITAMIN ","TAB 25MCG","90","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":""}]}]}