{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLIE   M BARNAK JR","gend":0,"add":"4265 MEADOW WOOD DR","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1954-04-25","age":"","mstatus":"","insh":"900047897*01","cliId":"4DC4R48DX98","pno":"757\/488-9775","cno":"757\/488-9775","email":"","ename":"","eno":"","pphy":"ABDELSHAHEED, SAMIR T MD","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":137859,"pcpname":"Family Medicine Health Care","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0007","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.49","I87.2","L84.","B35.1","L60.3","F17.210","M20.42","M20.41","Z12.2","Z87.891","Z23.","K21.9","E11.9","R07.9","E78.5","R60.0","G89.4","M15.0","M25.50","F32.9","R41.840","Z79.891","M47.817","M50.30","M51.36","M54.2","M54.5","M96.0","I20.9","J44.9","E55.9","I25.118","E11.65","I11.9","Z79.4","Z68.30","I25.10","G31.84","R26.0","I87.323","I83.893","I70.213","R42.","I25.119","I25.84","I10.","E78.00","F32.A","F03.90","Z79.899","Z79.84","Z79.82","R06.02","I25.110","Z01.818","R91.1","M54.9","M96.1","I65.23","I73.9"],"date":["2021-08-24","2021-09-30","2021-06-17","2021-06-17","2021-06-17","2021-10-15","2021-08-24","2021-08-24","2021-07-14","2021-07-14","2021-05-31","2021-10-15","2021-11-04","2021-08-11","2021-10-25","2021-10-15","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-06-30","2021-09-23","2021-06-30","2021-06-30","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-10-05","2021-11-04","2021-10-12","2021-10-25","2021-10-25","2021-10-25","2021-11-04","2021-10-25","2021-11-17","2021-06-21","2021-06-21","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-11-10","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-11-04","2021-11-04","2021-08-11","2021-08-11","2021-09-23","2021-09-30","2021-09-30"],"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]}},{"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":[["","591270801","OXYCODONE HCL ER","","90","Select","Select",""],["","59011048010","OXYCONTIN ","","90","Select","Select",""],["","6027754","JANUVIA ","","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS","","200","Select","Select",""],["","65862001305","SERTRALINE HYDROCHLORIDE","","-60","Select","Select",""],["","33342029815","MEMANTINE HYDROCHLORIDE","","60","Select","Select",""],["","53885004601","ONETOUCH ULTRA 2","","-1","Select","Select",""],["","69452015120","VITAMIN D ","","4","Select","Select",""],["","59011048010","OXYCONTIN","","90","Select","Select",""],["","69452015120","VITAMIN D","","4","Select","Select",""],["","00006027754","JANUVIA","","30","Select","Select",""],["","43598051010","ESOMEPRAZOLE MAGNESIUM","","90","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM","","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","","15","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM","25MG","90","Select","Select",""],["","65862080630","ARMODAFINIL","150MG","30","Select","Select",""],["","67877019810","AMLODIPINE BESYLATE","5MG","90","Select","Select",""],["","00406012510","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","10-325MG","90","Select","Select",""],["","46122061587","GNP ASPIRIN","81MG EC","90","Select","Select",""],["","00006027754","JANUVIA                                                               ","TAB 100MG","30","Select","Select",""],["","00591270801","OXYCODONE HCL ER                                                      ","TAB 80MG ER","90","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS                                            ","TES VERIO","200","Select","Select",""],["","59011048010","OXYCONTIN                                                             ","TAB 80MG CR","90","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM                                                  ","TAB 20MG","30","Select","Select",""],["","33342029815","MEMANTINE HYDROCHLORIDE                                               ","TAB HCL 10MG","60","Select","Select",""],["","65862001305","SERTRALINE HYDROCHLORIDE                                              ","TAB 100MG","60","Select","Select",""],["","53885004601","ONETOUCH ULTRA 2                                                      ","KIT ULTRA 2","-1","Select","Select",""],["","43598051010","ESOMEPRAZOLE MAGNESIUM                                                ","CAP 40MG DR","90","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","4","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","INJ 100\/ML","15","Select","Select",""],["","65862080630","ARMODAFINIL                                                           ","TAB 150MG","30","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM                                                    ","TAB 25MG","90","Select","Select",""],["","65862073205","AMIODARONE HYDROCHLORIDE                                              ","TAB 200MG","20","Select","Select",""],["","08222720130","GNP ULTICARE PEN NEEDLES 31G X 5MM                                    ","MIS 31GX5MM","100","Select","Select",""],["","69315011710","FUROSEMIDE                                                            ","TAB 40MG","30","Select","Select",""],["","69547035302","NARCAN                                                                ","SPR ","2","Select","Select",""],["","80681016000","HIGH POTENCY MULTIVITAMIN\/BETA-CAROTENE                               ","TAB BETA-CAR","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","Select","Select",""],["","00406012510","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 10-325MG","90","Select","Select",""],["","68001050103","METOPROLOL SUCCINATE ER                                               ","TAB 50MG ER","90","Select","Select",""],["","68462018022","MUPIROCIN                                                             ","OIN 0.02","22","Select","Select",""],["","67877019810","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","57664050658","METOPROLOL TARTRATE                                                   ","TAB 25MG","30","Select","Select",""],["","46122061587","GNP ASPIRIN                                                           ","TAB 81MG EC","90","Select","Select",""],["","27241012502","RANOLAZINE ER                                                         ","TAB 500MG ER","60","Select","Select",""],["","00904699880","DOCUSATE SODIUM                                                       ","CAP 100MG","60","Select","Select",""],["","68001044503","POTASSIUM CHLORIDE ER                                                 ","TAB 20MEQ ER","30","Select","Select",""],["","55111012705","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","20","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":""}]}]}