{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MILDRED   B REED","gend":1,"add":"136 BROAD ST","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1947-10-15","pno":"757\/793-6418","cno":"757\/793-6418","email":"","pphy":"MUGAISI, HESED N MD","ppno":"","pcpadd":"148 BURNETTS WAY STE 107","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":207896,"pcpname":"BON SECOURS SUFFOLK PRIMARY CARE","insh":"900048103*01","cliId":"4DM6NY7VN50","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"757\/793-6418","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-6935","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","R35.0","K21.9","R63.4","E66.3","Z12.11","E78.2","K20.90","K26.9","E11.9","I10.","K21.00","Z66.","K29.70","I12.9","I25.10","E78.5","N39.0","Z86.79","E11.43","Z91.19","N30.00","K31.84","N18.32","J45.40","I11.9","I05.9","N18.31","E11.22","E11.65","J45.909","E66.9","Z79.899","Z68.31","Z72.0","Z83.3","Z82.49","Z71.3","I08.8","Z79.4","Z71.89","R73.9","Z00.00","Z12.31","I95.2","E87.6","R10.84","R07.9","R10.10","D72.820","K31.89","R50.9","N18.30"],"date":["2021-11-12","2021-07-13","2021-07-16","2021-07-16","2021-07-16","2021-11-12","2021-07-09","2021-07-17","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-07-21","2021-07-21","2021-07-21","2021-08-26","2021-08-26","2021-10-10","2021-10-10","2021-11-12","2021-10-14","2021-10-14","2021-10-12","2021-07-03","2021-07-07","2021-08-24","2021-08-24","2021-07-07","2021-07-07","2021-07-07","2021-11-12","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-08-17","2021-10-12","2021-07-18","2021-06-25","2021-06-25","2021-10-22","2021-06-29","2021-06-29","2021-07-01","2021-07-01","2021-07-17","2021-07-17","2021-07-17","2021-10-12","2021-11-12"],"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]}},{"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":[["","65862078430","ESOMEPRA","40MG DR","90","Select","Select",""],["","62037099901","POT CL MICRO","20MEQ ER","4","Select","Select",""],["","65702040010","ACCU-CHEK","SOFTCLIX","1","Select","Select",""],["","70408014634","PROMETHAZINE","6.25\/5ML","100","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","-90","Select","Select",""],["","59762040101","SUCRALFATE","1GM","28","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","-30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","57664016758","METOPROL","100MG","180","Select","Select",""],["","94030000294","EMBRACE","STRIPS","300","Select","Select",""],["","65702028810","FASTCLIX","LANCETS","306","Select","Select",""],["","00597015330","JARDIANCE","25MG","90","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","90","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","-300","Select","Select",""],["","69097067905","PREGABALIN","75MG","180","Select","Select",""],["","00713052612","PROMETHEGAN","25MG","10","Select","Select",""],["","00093220401","METOCLOPRAM ","TAB 5MG","-90","Select","Select",""],["","65702040010","ACCU-CHEK ","KIT SOFTCLIX","1","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","90","Select","Select",""],["","65862078430","ESOMEPRA ","CAP 40MG DR","90","Select","Select",""],["","70408014634","PROMETHAZINE ","SOL 6.25\/5ML","100","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","-10","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","57664016758","METOPROL ","TAB 100MG","180","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","28","Select","Select",""],["","00378668977","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","65702028810","FASTCLIX ","MIS LANCETS","306","Select","Select",""],["","69097067905","PREGABALIN ","CAP 75MG","180","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","90","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","94030000294","EMBRACE ","TES STRIPS","300","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","90","Select","Select",""],["","53885024510","ONETOUCH ","TES ULTRA","300","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","00713052612","PROMETHEGAN ","SUP 25MG","10","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":""}]}]}