{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOY   L DAVIS","gend":1,"add":"977 NEWMANTOWN ROAD","city":"DUGSPUR","state":"VA","zip":"24325-9998","dob":"1967-02-04","age":"","mstatus":"","insh":"900047003*01","cliId":"3UU6GC7NC55","pno":"276\/728-0481","cno":"276\/728-0481","email":"","ename":"","eno":"","pphy":"MENEZES JR, ROBERT CHARLES MD","ppno":"276\/728-4311","pcpadd":"702 PINE STREET","pcpcity":"HILLSVILLE","pcpstate":"VA","pcpzip":24343,"pcpcounty":"","pcpid":171236,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/728-0901","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.41","N32.81","N39.44","R55.","Z12.31","Z86.010","Z71.9","K21.9","Z80.0","F25.9","E03.9","Z91.81","R51.9","I10.","F07.81","F20.9","G89.29","M54.41","M54.42","E66.9","M62.81","E78.5","F41.1","N39.3","Z74.1","Z79.899","D17.30","M25.552","E87.6","Z68.30","M54.2","M48.062","E55.9","N76.0","R92.8","S09.90XA","R51.0","H25.11","Z51.89","F25.0","H25.12","H25.042","R07.9","R30.0","Z11.3","R92.1","Z88.8","Z88.5","Z80.1","Z80.9","A63.0","R07.2","J44.9","Z91.048","Z79.1","E78.00","N30.20","R63.5","R29.6","Z12.4","N72.","K04.7","H10.13","R07.89","Z11.51","R06.09","R00.2","Z87.891","Z82.49","R06.02","Z51.81","R26.89","R94.31","N64.52","M25.561","M25.562","R00.0","Z01.419","R68.89","F41.0","R42.","L70.9","Z23.","R91.8","I20.9","R94.39","E88.81"],"date":["2021-05-23","2021-07-14","2021-07-14","2021-03-19","2021-04-21","2021-03-11","2021-07-27","2021-11-03","2021-03-11","2021-09-08","2021-07-27","2021-03-11","2021-09-28","2021-11-03","2021-07-06","2021-11-03","2021-06-06","2021-04-07","2021-04-07","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-04-26","2021-05-05","2021-04-26","2021-09-28","2021-05-05","2021-04-26","2021-10-15","2021-04-26","2021-07-27","2021-03-19","2021-09-24","2021-06-14","2021-10-04","2021-10-27","2021-06-14","2021-06-14","2021-11-05","2021-06-25","2021-06-25","2021-06-04","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-07-21","2021-06-28","2021-06-14","2021-06-14","2021-07-27","2021-07-14","2021-07-27","2021-07-27","2021-07-22","2021-07-22","2021-08-19","2021-08-19","2021-10-05","2021-07-22","2021-10-05","2021-11-05","2021-10-05","2021-10-05","2021-11-05","2021-10-29","2021-11-03","2021-10-15","2021-07-22","2021-09-24","2021-09-28","2021-10-15","2021-07-22","2021-08-21","2021-08-21","2021-10-04","2021-09-28","2021-09-28","2021-06-25","2021-09-21","2021-09-21","2021-10-15"],"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]}},{"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":[["","23155049001","DESMOPRESSIN","TAB 0.2MG","90","Select","Select",""],["","50458055201","INVEGA","TAB 9MG","28","Select","Select",""],["","57237001999","DULOXETINE","CAP 60MG","56","Select","Select",""],["","68382000905","LAMOTRIGINE","TAB 150MG","56","Select","Select",""],["","65862084601","CLOZAPINE","TAB 100MG","140","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","30","Select","Select",""],["","60505017007","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","43547040611","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","50458060901","INVEGA TRINZ","INJ 819MG","3","Select","Select",""],["","43386016101","MISOPROSTOL","TAB 200MCG","90","Select","Select",""],["","378180510","LEVOTHYROXIN","TAB 75MCG","30","Select","Select",""],["","62332001771","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","2","Select","Select",""],["","65862084601","CLOZAPINE ","","140","Select","Select",""],["","23155049001","DESMOPRESSIN ACETATE ","","90","Select","Select",""],["","60505017007","PRAVASTATIN SODIUM ","","30","Select","Select",""],["","378180377","LEVOTHYROXINE SODIUM ","","30","Select","Select",""],["","61442010310","DICLOFENAC SODIUM DR ","","60","Select","Select",""],["","57237001999","DULOXETINE HYDROCHLORIDE","","56","Select","Select",""],["","50458060901","INVEGA TRINZA ","","3","Select","Select",""],["","50458056401","INVEGA SUSTENNA ","","2","Select","Select",""],["","62332001771","METRONIDAZOLE ","","14","Select","Select",""],["","50458056401","INVEGA SUSTENNA","","2","Select","Select",""],["","60505017007","PRAVASTATIN SODIUM","","30","Select","Select",""],["","23155049001","DESMOPRESSIN ACETATE","","90","Select","Select",""],["","50458060901","INVEGA TRINZA","","3","Select","Select",""],["","00378180377","LEVOTHYROXINE SODIUM","","30","Select","Select",""],["","61442010310","DICLOFENAC SODIUM DR","","60","Select","Select",""],["","62332001771","METRONIDAZOLE","","14","Select","Select",""],["","43386048024","ORPHENADRINE CITRATE ER","","6","Select","Select",""],["","49483060350","IBUPROFEN","","24","Select","Select",""],["","59762332801","CLINDAMYCIN HCL","150MG","56","Select","Select",""],["","60505057501","OLOPATADINE HCL","0.001","5","Select","Select",""],["","68382065105","ISOSORBIDE MONONITRATE ER","60MG ER","30","Select","Select",""],["","45963041806","RANOLAZINE ER","500MG ER","60","Select","Select",""],["","51672139400","TRETINOIN","0.05%","20","Select","Select",""],["","50458055201","INVEGA                                                                ","TAB 9MG","28","Select","Select",""],["","50458056401","INVEGA SUSTENNA                                                       ","INJ 234\/1.5","2","Select","Select",""],["","43547040611","CLONAZEPAM                                                            ","TAB 0.5MG","60","Select","Select",""],["","64764017530","DEXILANT                                                              ","CAP 60MG DR","30","Select","Select",""],["","65862084601","CLOZAPINE                                                             ","TAB 100MG","140","Select","Select",""],["","68382000905","LAMOTRIGINE                                                           ","TAB 150MG","56","Select","Select",""],["","49483060350","IBUPROFEN                                                             ","TAB 600MG","24","Select","Select",""],["","57237001999","DULOXETINE HYDROCHLORIDE                                              ","CAP 60MG","56","Select","Select",""],["","00378180510","LEVOTHYROXINE SODIUM                                                  ","TAB 75MCG","30","Select","Select",""],["","61442010310","DICLOFENAC SODIUM DR                                                  ","TAB 75MG DR","60","Select","Select",""],["","50458060901","INVEGA TRINZA                                                         ","INJ 819MG","3","Select","Select",""],["","60505017007","PRAVASTATIN SODIUM                                                    ","TAB 40MG","30","Select","Select",""],["","23155049001","DESMOPRESSIN ACETATE                                                  ","TAB 0.2MG","90","Select","Select",""],["","43386016101","MISOPROSTOL                                                           ","TAB 200MCG","90","Select","Select",""],["","60505057501","OLOPATADINE HCL                                                       ","DRO 0.001","-15","Select","Select",""],["","43386048024","ORPHENADRINE CITRATE ER                                               ","TAB 100MG ER","6","Select","Select",""],["","59762332801","CLINDAMYCIN HCL                                                       ","CAP 150MG","56","Select","Select",""],["","23155002301","BUSPIRONE HYDROCHLORIDE                                               ","TAB 5MG","60","Select","Select",""],["","68180051303","LISINOPRIL                                                            ","TAB 5MG","90","Select","Select",""],["","55111012305","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","51672139400","TRETINOIN                                                             ","CRE 0.0005","20","Select","Select",""],["","00603020922","MAGNESIUM OXIDE                                                       ","TAB 400MG","180","Select","Select",""],["","00168025815","CLOTRIMAZOLE\/BETAMETHASONE DIPROPIONATE                               ","CRE DIPROP","15","Select","Select",""],["","62332001771","METRONIDAZOLE                                                         ","TAB 500MG","14","Select","Select",""],["","45963041806","RANOLAZINE ER                                                         ","TAB 500MG ER","60","Select","Select",""],["","68382065105","ISOSORBIDE MONONITRATE ER                                             ","TAB 60MG ER","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}