{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAIGE R MILLER","gend":1,"add":"287 E SOUTH BLVD","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1976-06-09","age":"","mstatus":"","insh":"900047682*01","cliId":"8X42W92FC14","pno":"347\/816-5240","cno":"347\/816-5240","email":"","ename":"","eno":"","pphy":"MOHIUDDIN, ABDUL Q MD","ppno":"804\/458-8583","pcpadd":"1012 WINSTON CHURCHIL","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":23860,"pcpcounty":"","pcpid":973164,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/541-2724","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","F43.23","G40.89","F43.21","N31.9","D64.9","E46.","R53.83","E55.9","E53.9","Z13.1","R60.9","G89.4","M79.7","G62.9","K21.9","I82.403","K59.00","G35.","N31.8","Z68.41","R31.0","R33.9","M19.90","E66.9","Z98.84","Z93.3","Z79.899","K31.9","E66.01","Z68.42","G82.20","J42.","F17.200","Z90.3","K29.71","K31.89","L60.0","B35.3","B35.1","N39.0","K29.70","Z01.818","S22.081A","L29.8","M54.5","L08.9","R31.9","B37.2","Z43.3","E11.9","Z68.43","R12.","Z72.0","Z01.812","Z20.822","G82.22","K92.1","I10.","K52.89","M54.30","Z79.1","L24.9","L81.0","L20.89","F31.32","Z12.11","K21.00","K29.50","K44.9","K22.70","M19.91","Z87.19","Z99.3","L70.0","M54.59","K52.9","L70.9","K20.90"],"date":["2021-11-18","2021-11-18","2021-04-19","2021-10-01","2021-10-12","2021-09-10","2021-04-27","2021-04-27","2021-09-09","2021-04-27","2021-04-27","2021-06-19","2021-07-01","2021-09-10","2021-10-08","2021-10-26","2021-10-08","2021-04-19","2021-10-26","2021-11-17","2021-08-18","2021-05-04","2021-05-04","2021-09-10","2021-09-23","2021-06-18","2021-11-09","2021-11-09","2021-10-26","2021-10-26","2021-06-18","2021-10-26","2021-06-18","2021-06-18","2021-10-12","2021-06-18","2021-10-26","2021-09-20","2021-09-20","2021-09-20","2021-07-13","2021-06-18","2021-06-18","2021-07-08","2021-10-08","2021-09-02","2021-09-17","2021-07-01","2021-07-01","2021-10-12","2021-10-26","2021-11-17","2021-10-12","2021-09-09","2021-10-22","2021-10-22","2021-10-01","2021-10-01","2021-10-26","2021-09-10","2021-09-10","2021-09-10","2021-10-01","2021-10-01","2021-10-01","2021-11-18","2021-09-10","2021-11-09","2021-11-09","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-08-23","2021-10-08","2021-09-10","2021-09-19","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,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":[["","55150025110","LIDOCAINE","INJ 0.01","10","Select","Select",""],["","47335061930","DRIZALMA","CAP 60MG DR","28","Select","Select",""],["","781320895","CEFTRIAXONE","INJ 1GM","-5","Select","Select",""],["","47781023005","OXYCOD\/APAP","TAB 10-325MG","30","Select","Select",""],["","574014560","TROSPIUM CL","TAB 20MG","28","Select","Select",""],["","31722053705","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","50458057760","XARELTO","TAB 2.5MG","60","Select","Select",""],["","33342015615","CELECOXIB","CAP 100MG","60","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","150","Select","Select",""],["","50111045002","TRAZODONE","TAB 150MG","30","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","781502207","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877022410","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","591352530","LIDOCAINE ","","75","Select","Select",""],["","47781023005","OXYCODONE\/ACETAMINOPHEN","","30","Select","Select",""],["","781320895","CEFTRIAXONE SODIUM ","","5","Select","Select",""],["","409427616","LIDOCAINE HCL ","","20","Select","Select",""],["","781502207","METHYLPREDNISOLONE DOSE PACK","","21","Select","Select",""],["","50458057760","XARELTO ","","60","Select","Select",""],["","65862001105","SERTRALINE HCL","","150","Select","Select",""],["","50111045002","TRAZODONE HYDROCHLORIDE","","30","Select","Select",""],["","47335061930","DRIZALMA SPRINKLE","","28","Select","Select",""],["","574014560","TROSPIUM CHLORIDE","","28","Select","Select",""],["","70010075405","METHOCARBAMOL ","","180","Select","Select",""],["","33342015615","CELECOXIB ","","60","Select","Select",""],["","59011041510","OXYCONTIN ","","28","Select","Select",""],["","31722053705","LEVETIRACETAM ","","60","Select","Select",""],["","43386043201","OXYCODONE HYDROCHLORIDE","","30","Select","Select",""],["","68462015713","ONDANSETRON ODT ","","120","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","14","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","","10","Select","Select",""],["","00781320895","CEFTRIAXONE SODIUM","","-5","Select","Select",""],["","55150025110","LIDOCAINE HCL","","10","Select","Select",""],["","31722053705","LEVETIRACETAM","","60","Select","Select",""],["","59011041510","OXYCONTIN","","28","Select","Select",""],["","68462015713","ONDANSETRON ODT","","120","Select","Select",""],["","00143980305","DOXYCYCLINE HYCLATE","","28","Select","Select",""],["","42858080101","MORPHINE SULFATE ER","","28","Select","Select",""],["","24510011010","XTAMPZA ER","","28","Select","Select",""],["","70010075405","METHOCARBAMOL","","180","Select","Select",""],["","00378912198","FENTANYL","","5","Select","Select",""],["","59011027560","HYSINGLA ER","","28","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","","8","Select","Select",""],["","68462039610","OMEPRAZOLE","","2","Select","Select",""],["","65162044211","MECLIZINE HYDROCHLORIDE","","60","Select","Select",""],["","59627022205","AVONEX","30MCG","1","Select","Select",""],["","00143992950","CIPROFLOXACIN HCL","750MG","20","Select","Select",""],["","57237001999","DULOXETINE HYDROCHLORIDE","60MG","60","Select","Select",""],["","00574222520","TRETINOIN","0.00025","20","Select","Select",""],["","45802090096","CLINDAMYCIN PHOSPHATE","0.01","60","Select","Select",""],["","67877025180","TRIAMCINOLONE ACETONIDE","0.001","80","Select","Select",""],["","00713068331","GENTAMICIN SULFATE","0.001","30","Select","Select",""],["","10572010001","PEG-3350\/ELECTROLYTES","ELECTROL","4000","Select","Select",""],["","45802045384","ADAPALENE","0.10%","45","Select","Select",""],["","65862019399","FLUOXETINE HCL","20MG","30","Select","Select",""],["","00781320895","CEFTRIAXONE SODIUM ","INJ 1GM","1","Select","Select",""],["","65862001105","SERTRALINE HCL ","TAB 25MG","150","Select","Select",""],["","50111045002","TRAZODONE HYDROCHLORIDE ","TAB 150MG","30","Select","Select",""],["","47335061930","DRIZALMA SPRINKLE ","CAP 60MG DR","28","Select","Select",""],["","43386043201","OXYCODONE HYDROCHLORIDE ","TAB 5MG","30","Select","Select",""],["","31722053705","LEVETIRACETAM ","TAB 500MG","60","Select","Select",""],["","68462015713","ONDANSETRON ODT ","TAB 4MG ODT","120","Select","Select",""],["","24510011010","XTAMPZA ER ","CAP 9MG","-28","Select","Select",""],["","00378912198","FENTANYL ","DIS 25MCG\/HR","5","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","75","Select","Select",""],["","47781023005","OXYCODONE\/ACETAMINOPHEN ","TAB 10-325MG","-30","Select","Select",""],["","50458057760","XARELTO ","TAB 2.5MG","60","Select","Select",""],["","55150025110","LIDOCAINE HCL ","INJ 0.01","10","Select","Select",""],["","33342015615","CELECOXIB ","CAP 100MG","60","Select","Select",""],["","00781502207","METHYLPREDNISOLONE DOSE PACK ","TAB 4MG","21","Select","Select",""],["","00574014560","TROSPIUM CHLORIDE ","TAB 20MG","28","Select","Select",""],["","67877022410","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","59011041510","OXYCONTIN ","TAB 15MG CR","28","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","59627022205","AVONEX ","KIT 30MCG","1","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS ","CAP 100MG","10","Select","Select",""],["","59011027560","HYSINGLA ER ","TAB 80 MG","28","Select","Select",""],["","00143980305","DOXYCYCLINE HYCLATE ","CAP 100MG","2","Select","Select",""],["","70010075405","METHOCARBAMOL ","TAB 500MG","180","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS ","TAB 800-160","14","Select","Select",""],["","57237001999","DULOXETINE HYDROCHLORIDE ","CAP 60MG","60","Select","Select",""],["","45802005611","GENTAMICIN SULFATE ","CRE 0.001","-30","Select","Select",""],["","45802090096","CLINDAMYCIN PHOSPHATE ","GEL 0.01","60","Select","Select",""],["","00143992950","CIPROFLOXACIN HCL ","TAB 750MG","20","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","2","Select","Select",""],["","42858080101","MORPHINE SULFATE ER ","TAB 15MG ER","-28","Select","Select",""],["","00574222520","TRETINOIN ","CRE 0.00025","20","Select","Select",""],["","65162044211","MECLIZINE HYDROCHLORIDE ","TAB 25MG","60","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA ","AER HFA","8","Select","Select",""],["","51672128202","TRIAMCINOLONE ACETONIDE ","CRE 0.001","30","Select","Select",""],["","45802045384","ADAPALENE ","CRE 0.001","-45","Select","Select",""],["","65862019399","FLUOXETINE HCL ","CAP 20MG","30","Select","Select",""],["","00832046530","NYAMYC ","POW 100000","30","Select","Select",""],["","69097052444","DICLOFENAC SODIUM ","GEL 0.01","100","Select","Select",""],["","10572010001","PEG-3350\/ELECTROLYTES ","SOL ELECTROL","4000","Select","Select",""],["","00093227534","AMOXICILLIN\/CLAVULANATE POTASSIUM ","TAB 875-125","10","Select","Select",""],["","65862022801","LAMOTRIGINE ","TAB 100MG","60","Select","Select",""],["","00054418625","DEXAMETHASONE ","TAB 6MG","10","Select","Select",""],["","65862019401","FLUOXETINE HYDROCHLORIDE ","CAP 40MG","30","Select","Select",""],["","00781808931","AZITHROMYCIN ","TAB 250MG","2","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","",""],["No","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":""}]}]}