{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SABINA BARLOW","gend":1,"add":"204 SHORTLEAF CT APT 103","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1962-05-30","age":"","mstatus":"","insh":"900048758*01","cliId":"5D00WC8PY08","pno":"757\/947-4561","cno":"757\/947-4561","email":"","ename":"","eno":"","pphy":"WHITEHURST, CANDACE MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":207883,"pcpname":"BON SECOURS GHENT STATION MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"757\/947-4561","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","J98.4","I21.4","I25.10","I12.0","N18.6","Z99.2","E11.22","D64.9","E78.00","R11.2","E11.3512","H43.12","E11.3511","H40.89","Z79.4","H21.01","H43.812","H43.11","Z96.1","H25.12","M79.602","I10.","J44.0","J18.9","J96.01","I13.2","I50.32","D63.1","E11.43","K31.84","M19.91","M10.9","E78.5","M81.0","L87.0","E11.3599","E11.65","N18.4","I25.110","I21.3","I45.10","E87.6","J45.909","J98.11","R03.0","E11.9","J90.","Z87.19","D50.9","R06.02","E87.79","I50.23","E83.9","M67.472","M21.751","L85.3","E11.42","R26.2","M79.672","B35.1","I22.8","F17.210","E88.09","J44.9","Z79.899","D57.3","I44.5","R10.13","Z87.891","R10.84","N26.1","N20.0","T81.89XA","R74.8","G47.33","N25.81","Z91.041","Z88.5","Z86.73","T82.855A","I25.118","E87.70","Z86.718","I25.5","E87.1","T82.41XA","K21.9","E11.319","Z96.41","R53.81","I95.9","D63.8","R07.89","I50.9","H40.9","Z88.8","Z96.641","D50.8","K59.09","R94.31","Z12.31","I50.22","R00.2","I50.20","T82.590A","K59.00","B37.9","Z74.3","T82.858A","T82.510A","I12.9","M19.90","M62.50","Z95.5","Z96.652","I21.19","E11.36","F41.9","Z09.","Z76.0","Z68.25","E11.29","Z46.81","I42.9","I50.21","G64.","R06.01","R79.89","I25.2","Z23."],"date":["2021-10-31","2021-08-14","2021-10-04","2021-10-04","2021-10-31","2021-11-15","2021-10-31","2021-10-28","2021-10-27","2021-09-09","2021-10-31","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-08-09","2021-08-09","2021-11-19","2021-08-09","2021-08-09","2021-08-17","2021-10-04","2021-08-01","2021-08-01","2021-10-04","2021-10-28","2021-10-28","2021-10-27","2021-10-27","2021-10-05","2021-10-04","2021-10-04","2021-10-04","2021-09-14","2021-08-30","2021-08-01","2021-10-04","2021-08-20","2021-10-04","2021-09-04","2021-09-09","2021-09-04","2021-09-13","2021-09-03","2021-09-03","2021-09-14","2021-09-03","2021-09-03","2021-10-04","2021-09-14","2021-09-07","2021-10-04","2021-09-14","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-09-02","2021-09-13","2021-09-02","2021-10-04","2021-10-27","2021-09-09","2021-09-03","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-11-15","2021-09-09","2021-09-14","2021-10-27","2021-10-05","2021-10-27","2021-10-27","2021-08-18","2021-08-14","2021-09-03","2021-10-27","2021-10-04","2021-08-20","2021-08-16","2021-10-27","2021-08-16","2021-10-27","2021-08-24","2021-08-24","2021-09-14","2021-09-14","2021-09-14","2021-10-04","2021-10-27","2021-10-27","2021-08-21","2021-08-21","2021-09-02","2021-09-28","2021-10-04","2021-10-04","2021-08-19","2021-08-19","2021-08-22","2021-08-19","2021-08-19","2021-08-30","2021-08-30","2021-08-16","2021-09-14","2021-08-30","2021-08-30","2021-08-30","2021-09-09","2021-09-14","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-27","2021-09-27","2021-08-20","2021-08-23","2021-09-03","2021-09-08","2021-09-08","2021-09-09","2021-10-02"],"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,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,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":[["","00054001925","PREDNISONE","50MG","3","Select","Select",""],["","50383066730","LIDOCAINE\/PRILOCAINE","2.5-2.5%","30","Select","Select",""],["","13811052501","TRIPHROCAPS","","30","Select","Select",""],["","00186077760","BRILINTA","90MG","60","Select","Select",""],["","17478007035","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","00093005105","CARVEDILOL","3.125MG","60","Select","Select",""],["","27808015601","ROSUVASTATIN CALCIUM","10MG","30","Select","Select",""],["","27808008601","HYDROCODONE POLISTIREX\/CHLORPHENIRAMINE POLISTIREX","10-8\/5ML","70","Select","Select",""],["","69680014395","SEVELAMER CARBONATE","800MG","270","Select","Select",""],["","11822033209","RA ALLERGY RELIEF","25MG","2","Select","Select",""],["","13107008301","LORAZEPAM","0.5MG","-60","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1%","200","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","90","Select","Select",""],["","69238106901","POTASSIUM CHLORIDE ER","20MEQ ER","3","Select","Select",""],["","00245021211","MIDODRINE HCL","5MG","45","Select","Select",""],["","00172392560","DIAZEPAM","2MG","60","Select","Select",""],["","29300039705","AMLODIPINE BESYLATE","5MG","90","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","10","Select","Select",""],["","13107008301","LORAZEPAM                                                             ","TAB 0.5MG","-60","Select","Select",""],["","65862035790","CLOPIDOGREL                                                           ","TAB 75MG","90","Select","Select",""],["","50383066730","LIDOCAINE\/PRILOCAINE                                                  ","CRE 2.5-2.5%","30","Select","Select",""],["","00186077760","BRILINTA                                                              ","TAB 90MG","60","Select","Select",""],["","13811052501","TRIPHROCAPS                                                           ","CAP ","30","Select","Select",""],["","17478007035","ERYTHROMYCIN                                                          ","OIN 5MG\/GM","4","Select","Select",""],["","27808015701","ROSUVASTATIN CALCIUM                                                  ","TAB 20MG","90","Select","Select",""],["","00169750111","NOVOLOG                                                               ","INJ 100\/ML","10","Select","Select",""],["","68462011944","FLUCONAZOLE                                                           ","TAB 150MG","4","Select","Select",""],["","00245021211","MIDODRINE HCL                                                         ","TAB 5MG","-45","Select","Select",""],["","29300039705","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","68382009201","CARVEDILOL                                                            ","TAB 3.125MG","60","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","GEL 0.01","200","Select","Select",""],["","63304061650","DOXYCYCLINE MONOHYDRATE                                               ","CAP 100MG","90","Select","Select",""],["","00054001925","PREDNISONE                                                            ","TAB 50MG","-3","Select","Select",""],["","27808003501","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","6","Select","Select",""],["","00172392560","DIAZEPAM                                                              ","TAB 2MG","60","Select","Select",""],["","27808008601","HYDROCODONE POLISTIREX\/CHLORPHENIRAMINE POLISTIREX                    ","SUS 10-8\/5ML","70","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","30","Select","Select",""],["","11822033209","RA ALLERGY RELIEF                                                     ","CAP 25MG","2","Select","Select",""],["","69680014395","SEVELAMER CARBONATE                                                   ","TAB 800MG","270","Select","Select",""],["","69238106901","POTASSIUM CHLORIDE ER                                                 ","TAB 20MEQ ER","3","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":""}]}]}