{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA   J PRUITT","gend":1,"add":"4 COWLES CIR","city":"POQUOSON","state":"VA","zip":"23662-9998","dob":"1941-08-18","age":"","mstatus":"","insh":"900047543*01","cliId":"8JF2JK9MA83","pno":"757\/876-9564","cno":"757\/876-9564","email":"","ename":"","eno":"","pphy":"TAYLOR, KEITH MD","ppno":"757\/877-0214","pcpadd":"13347 WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":157508,"pcpname":"DENBIGH FAMILY MEDICINE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/875-0524","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","J44.1","R53.1","H92.01","J44.9","J96.11","R93.89","I50.22","Z87.891","R39.89","I25.110","Z95.1","Z95.5","N28.9","E87.5","I73.9","Z95.820","D64.9","E78.5"],"date":["2021-05-06","2021-05-03","2021-05-03","2021-04-22","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-05-28","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-08-11","2021-07-19"],"priorHcc":["","","","",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":[["","527058601","DICYCLOMINE","CAP 10MG","60","Select","Select",""],["","173088710","TRELEGY","AER ELLIPTA","-60","Select","Select",""],["","121077516","GG\/CODEINE","SOL 100-10\/5","180","Select","Select",""],["","50742061501","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","54429931","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","16729017001","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","173088710","TRELEGY ELLIPTA ","","-60","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","","90","Select","Select",""],["","527058601","DICYCLOMINE HYDROCHLORIDE ","","60","Select","Select",""],["","59746021601","SPIRONOLACTONE","","90","Select","Select",""],["","50742061501","METOPROLOL SUCCINATE ER","","90","Select","Select",""],["","16729017001","ESCITALOPRAM OXALATE ","","30","Select","Select",""],["","72647033104","METHYLPREDNISOLONE ","","21","Select","Select",""],["","68462063945","NITROGLYCERIN ","","25","Select","Select",""],["","121077516","GUAIFENESIN\/CODEINE","","180","Select","Select",""],["","31722070090","LOSARTAN POTASSIUM ","","45","Select","Select",""],["","172392760","DIAZEPAM","","60","Select","Select",""],["","72647033104","METHYLPREDNISOLONE","","21","Select","Select",""],["","16729017001","ESCITALOPRAM OXALATE","","30","Select","Select",""],["","00173088710","TRELEGY ELLIPTA","","60","Select","Select",""],["","00527058601","DICYCLOMINE HYDROCHLORIDE","","60","Select","Select",""],["","31722070090","LOSARTAN POTASSIUM","","45","Select","Select",""],["","68462063945","NITROGLYCERIN","","25","Select","Select",""],["","13668010501","ISOSORBIDE MONONITRATE ER","","90","Select","Select",""],["","68180063709","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","62332025118","AZITHROMYCIN                                                          ","TAB 250MG","6","Select","Select",""],["","00173088710","TRELEGY ELLIPTA                                                       ","AER ELLIPTA","60","Select","Select",""],["","13668010501","ISOSORBIDE MONONITRATE ER                                             ","TAB 60MG ER","90","Select","Select",""],["","68180063709","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","16729017001","ESCITALOPRAM OXALATE                                                  ","TAB 20MG","30","Select","Select",""],["","00121077516","GUAIFENESIN\/CODEINE                                                   ","SOL 100-10\/5","180","Select","Select",""],["","00054429931","FUROSEMIDE                                                            ","TAB 40MG","90","Select","Select",""],["","00527058601","DICYCLOMINE HYDROCHLORIDE                                             ","CAP 10MG","60","Select","Select",""],["","72647033104","METHYLPREDNISOLONE                                                    ","TAB 4MG","21","Select","Select",""],["","59746021601","SPIRONOLACTONE                                                        ","TAB 25MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","90","Select","Select",""],["","31722070090","LOSARTAN POTASSIUM                                                    ","TAB 25MG","45","Select","Select",""],["","50742061501","METOPROLOL SUCCINATE ER                                               ","TAB 25MG ER","90","Select","Select",""],["","68462063945","NITROGLYCERIN                                                         ","SUB 0.4MG","25","Select","Select",""],["","00172392760","DIAZEPAM                                                              ","TAB 10MG","60","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","",""],["No","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":""}]}]}