{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHEZ   ANN R CLAWSON","gend":1,"add":"342 GOOD MILL ROAD","city":"RILEYVILLE","state":"VA","zip":"22650-9998","dob":"1963-11-07","age":"","mstatus":"","insh":"900048043*01","cliId":"5QF7GT3AM32","pno":"540\/244-8390","cno":"540\/244-8390","email":"","ename":"","eno":"","pphy":"DINH, PHUONG MD","ppno":"540\/743-2887","pcpadd":"135 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":104675,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/743-1288","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","I10.","M25.561","M25.562","E55.9","E11.621","E78.5","L97.529","E11.628","L03.116","M72.2","M19.072","R93.6","R73.9","Z03.89","L97.521","J98.8","J95.00","I27.21","E11.8","Z04.9","S20.95XA","L97.511","Z23.","Z55.0","Z91.89","Z91.19","M86.60","T17.908A","R22.42","Z20.822","J95.09","L03.115","M79.671","Z93.0","R60.0","L53.9","M86.8X8"],"date":["2021-11-11","2021-07-18","2021-05-13","2021-05-13","2021-07-27","2021-11-11","2021-07-01","2021-07-27","2021-07-22","2021-09-27","2021-07-14","2021-07-14","2021-07-14","2021-07-18","2021-09-26","2021-07-18","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-10-26","2021-10-26","2021-09-06","2021-10-20","2021-10-20","2021-11-11"],"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]}},{"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":[["","000169255013","TRESIBA ","200UNIT","27","Select","Select",""],["","000002773701","INSULIN ","100\/ML","10","Select","Select",""],["","042571016142","AMOX\/K ","500-125","30","Select","Select",""],["","050458014030","INVOKANA ","100MG","30","Select","Select",""],["","000093505898","ATORVASTATIN ","40MG","90","Select","Select",""],["","000054430129","FUROSEMIDE ","80MG","90","Select","Select",""],["","067877021905","CEPHALEXIN ","500MG","21","Select","Select",""],["","00169255013","","200UNIT","27","Select","Select",""],["","00169255013","TRESIBA","200UNIT","27","Select","Select",""],["","00002822259","INSULIN","100\/ML","15","Select","Select",""],["","00054430129","FUROSEMIDE","80MG","90","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","50458014090","INVOKANA","100MG","30","Select","Select",""],["","29300022019","MONTELUKAST","10MG","90","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","00574200802","NYSTOP","100000","60","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","90","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":""}]}]}