{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAWRENCE WILLIS","gend":0,"add":"3230 CLIFF AVE","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1955-05-08","age":"","mstatus":"","insh":"900047982*01","cliId":"8G37U34NM71","pno":"804\/204-9268","cno":"804\/204-9268","email":"","ename":"","eno":"","pphy":"MANTZOURIS, TAMMY J MD","ppno":"804\/828-5883","pcpadd":"401 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":103190,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.3","C61.","C79.51","R41.0","C77.9","C78.7","C79.70","Z87.891","R20.0","R53.1","E87.8","S24.109A","M25.512","K59.2","N31.9","R44.3","M48.54XA","R09.89","C79.49","C79.89","Z19.1","G82.21","Z98.1","G95.29","N13.30","D62.","D72.829","G82.20","Z85.46","M84.58XA","R00.0","I87.8","R91.8","E87.1","I26.99","L89.159","K21.9","F32.9","N13.6","S22.051A","F05.","S32.051A","K56.7","E87.5","K59.00","R14.0","M84.48XD","S24.103S","Z96.0","K63.89","J98.11","M47.819","L97.529","K59.09","S14.109D","F41.9","Z45.2","K76.9","R07.1","T84.226A","I51.89","R07.9","R94.31","M46.28","L89.154","R64.","M84.422A","Z20.822","L89.620","Z88.4","Z86.711","Z86.718","Z80.42","D63.8","N40.1","M48.04","G47.00","Z03.818","F33.8","M43.24","M62.59","M62.81","E87.2","I82.402","E83.42","M54.9","F33.1","F43.20","F41.8","M48.54XD","I26.93","S42.202A","M81.0","R62.7","R82.81","R07.89","Z79.01","D63.0","M79.602","R63.0","M84.522A","R41.82","Z74.01","N17.9","I95.9","A41.9","R65.21","N39.0","D64.9","R10.9","J90.","F39.","Z66.","J18.9","R33.9","Z98.890","R33.8","E55.9","L89.150","L89.626","L89.616","R52.","R10.13","L89.629","F45.42","C79.82","R63.4","M62.84","M19.012","M85.812","Z04.6","R50.9","M84.48XA","I77.810","R79.9","L89.90","E43.","R79.0"],"date":["2021-08-08","2021-08-08","2021-07-09","2021-05-10","2021-06-10","2021-06-22","2021-06-10","2021-07-02","2021-04-24","2021-04-24","2021-04-27","2021-05-03","2021-05-10","2021-06-01","2021-06-01","2021-05-03","2021-05-10","2021-05-04","2021-04-25","2021-04-29","2021-04-29","2021-05-10","2021-07-06","2021-04-25","2021-07-09","2021-04-29","2021-07-31","2021-07-08","2021-05-11","2021-06-04","2021-07-31","2021-05-09","2021-08-01","2021-06-02","2021-07-09","2021-08-08","2021-07-09","2021-07-09","2021-06-10","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-05-10","2021-06-30","2021-06-30","2021-06-01","2021-06-01","2021-06-11","2021-05-09","2021-08-01","2021-05-09","2021-06-30","2021-06-30","2021-05-26","2021-05-26","2021-05-12","2021-06-02","2021-06-02","2021-06-04","2021-06-03","2021-07-02","2021-06-30","2021-07-08","2021-07-02","2021-07-08","2021-07-09","2021-07-02","2021-07-02","2021-07-02","2021-08-07","2021-08-07","2021-07-02","2021-07-02","2021-06-01","2021-06-01","2021-07-09","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-10","2021-06-02","2021-07-09","2021-06-02","2021-07-08","2021-05-20","2021-05-20","2021-06-01","2021-06-01","2021-06-02","2021-06-29","2021-06-29","2021-07-02","2021-08-01","2021-07-02","2021-07-07","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-31","2021-07-08","2021-08-08","2021-07-31","2021-08-08","2021-08-08","2021-08-02","2021-08-07","2021-08-08","2021-08-03","2021-08-07","2021-08-02","2021-08-08","2021-07-09","2021-06-10","2021-06-11","2021-06-22","2021-08-01","2021-06-11","2021-06-11","2021-07-31","2021-06-30","2021-06-30","2021-07-03","2021-07-09","2021-07-06","2021-07-07","2021-07-06","2021-07-06","2021-06-07","2021-06-02","2021-06-22","2021-08-01","2021-07-02","2021-07-02","2021-07-09","2021-07-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68382013201","TAMSULOSIN HYDROCHLORIDE","","-90","Select","Select",""],["","00003089421","ELIQUIS","","60","Select","Select",""],["","65162062711","TRAMADOL HCL","","15","Select","Select",""],["","43199001101","HYOSCYAMINE SULFATE","","30","Select","Select",""],["","62175061743","PANTOPRAZOLE SODIUM","","30","Select","Select",""],["","50111033401","METRONIDAZOLE","","10","Select","Select",""],["","00832532510","POTASSIUM CHLORIDE ER","","4","Select","Select",""],["","00603188010","LIDOCAINE","","10","Select","Select",""],["","27241009990","DULOXETINE HYDROCHLORIDE","","30","Select","Select",""],["","57664051083","MIRTAZAPINE","7.5MG","30","Select","Select",""],["","50484001030","SANTYL","250\/GM","30","Select","Select",""],["","00378911998","FENTANYL","12MCG\/HR","5","Select","Select",""],["","10702005601","OXYCODONE HYDROCHLORIDE","10MG","15","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":""}]}]}