{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA   K MILES","gend":1,"add":"19278 BEAVERDAM RD","city":"BEAVERDAM","state":"VA","zip":"23015-9998","dob":"1959-08-07","age":"","mstatus":"","insh":"900034966*01","cliId":"","pno":"804\/449-1479","cno":"","email":"","ename":"","eno":"","pphy":"ESSAH, PAULINA A MD","ppno":"804\/798-9208","pcpadd":"STE C 306 ASHCAKE RD","pcpcity":"ASHLAND","pcpstate":"VA","pcpzip":23005,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS INTERNAL MEDICINE OF ASHLAND","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/798-8108","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.83","G47.10","J45.909","F31.12","Z12.4","Z01.419","Z11.51","Z00.00","E78.2","M89.9","Z87.39","N39.0","R31.9","E03.9","Z11.59","Z76.89","N18.2","E55.9","I10.","I12.9","K80.10","I25.10","K76.0","Z87.442","M81.0","G51.0","Z85.850","Z79.899","Z79.51","K80.20","F31.81","F41.9","K21.9","Z12.11","F31.9","G47.00","Z68.33","R53.83","R42.","R73.09","J06.9","G25.81","Z71.3","Z68.34","R10.11","M54.6","R07.1","J45.20","Z87.19","I51.7","I95.9","R00.0","R07.9","R06.09","N30.01","R53.82","N28.1","N20.0","C73.","D22.9","H90.3","Z96.651","M17.11","Z20.828","Z71.9","J98.4","Z91.09","R07.89","M54.31","R10.9","R73.03","E66.01","F06.4","F41.0","J45.998","J30.9","R05.","M41.84","M47.814","R93.5","Z68.35","I95.2","N18.1","R39.15","Z79.890","I73.9","Z68.36","R06.00","R00.2","M85.851","Z01.812","Z20.822","G47.33","Z92.29","F31.4","F31.77","R10.13","Z12.31","R80.9","E89.0","C75.9","L25.5","R19.5","J40.","E66.9","Z90.49","R60.9","Z79.82","R09.81","R35.0","J98.11","Z13.1","R10.84","K59.00","Z98.890","K57.30","Z96.653","M17.0","Z23.","Z13.820","M85.80","Z78.0","R06.89","K80.11"],"date":["2019-05-16","2019-02-07","2021-12-16","2019-09-16","2021-01-27","2019-09-19","2019-09-19","2021-01-25","2021-08-16","2019-12-20","2021-03-08","2019-12-20","2019-12-20","2021-12-16","2019-12-20","2020-10-02","2021-08-17","2021-08-30","2021-12-16","2021-08-30","2021-08-06","2021-12-16","2021-08-06","2021-08-06","2021-09-09","2021-08-06","2021-12-16","2021-12-16","2021-12-16","2021-08-16","2021-10-11","2021-10-11","2021-11-19","2021-12-16","2019-11-12","2019-10-29","2021-12-16","2019-06-19","2019-11-12","2018-12-18","2019-02-09","2019-03-27","2019-03-27","2021-08-16","2021-07-17","2019-06-26","2019-06-19","2019-07-15","2019-06-19","2019-07-05","2019-11-12","2020-10-19","2021-05-14","2021-05-04","2019-11-12","2019-11-12","2021-05-19","2021-05-19","2021-09-09","2019-11-12","2020-06-18","2020-11-09","2020-11-09","2020-12-28","2021-11-11","2021-05-07","2021-11-11","2021-05-14","2021-05-14","2021-07-17","2021-08-16","2021-12-16","2021-08-16","2021-08-16","2019-01-11","2021-11-11","2019-02-09","2019-06-26","2019-06-26","2019-06-26","2021-03-02","2020-10-19","2021-08-30","2019-11-05","2019-11-05","2021-03-02","2021-01-25","2021-07-21","2020-10-19","2021-03-08","2021-12-10","2021-12-10","2019-03-21","2019-06-06","2019-04-12","2021-03-02","2021-07-17","2021-04-13","2019-08-02","2021-02-26","2021-02-26","2021-07-09","2021-12-16","2021-11-11","2021-11-11","2021-11-11","2018-12-07","2019-02-09","2019-02-09","2019-11-05","2021-05-04","2021-02-03","2021-07-17","2021-07-17","2021-07-17","2021-12-16","2019-11-06","2019-11-06","2019-12-20","2021-03-08","2021-03-08","2021-03-08","2021-07-21","2021-08-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877019790","AMLODIPINE BESYLATE                                                   ","2.5MG","90","Select","Select",""],["","58160082311","SHINGRIX                                                              ","50MCG","1","Select","Select",""],["","16729020201","BUSPIRONE HYDROCHLORIDE                                               ","10MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE                                                           ","25MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE                                                            ","40MG","30","Select","Select",""],["","00173088210","BREO ELLIPTA                                                          ","200-25","60","Select","Select",""],["","16729011917","MONTELUKAST SODIUM                                                    ","10MG","30","Select","Select",""],["","00037024523","DYMISTA                                                               ","137-50","23","Select","Select",""],["","69238183501","LEVOTHYROXINE SODIUM                                                  ","112MCG","30","Select","Select",""],["","60505095303","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE                       ","137-50","23","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","","8","Select","Select",""],["","00781531710","ZOLPIDEM TARTRATE                                                     ","5MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","HFA","8","Select","Select",""],["","70461032003","FLUCELVAX QUADRIVALENT 2020-2021                                      ","2020-21","0","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","65862001501","AMOXICILLIN                                                           ","875MG","20","Select","Select",""],["","68001041306","DULOXETINE HYDROCHLORIDE                                              ","20MG","30","Select","Select",""],["","43547039910","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","5MG","21","Select","Select",""],["","43199001101","HYOSCYAMINE SULFATE                                                   ","0.125MG","10","Select","Select",""],["","45802006405","TRIAMCINOLONE ACETONIDE                                               ","0.10%","15","Select","Select",""],["","68001000501","METHYLPREDNISOLONE DOSE PACK                                          ","4MG","21","Select","Select",""],["","65862039010","ONDANSETRON ODT                                                       ","4MG ODT","10","Select","Select",""],["","00406012310","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","5-325MG","-12","Select","Select",""],["","10572010001","PEG-3350\/ELECTROLYTES                                                 ","ELECTROL","-4000","Select","Select",""],["","52268010001","GOLYTELY                                                              ","","4000","Select","Select",""],["","70461032103","FLUCELVAX QUADRIVALENT 2021-2022                                      ","2021-22","0","Select","Select",""],["","00781552810","BUPROPION HYDROCHLORIDE ER (XL)                                       ","150MG XL","30","Select","Select",""],["","52268020101","SUTAB                                                                 ","","24","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}