{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA   S SURPRISE","gend":1,"add":"7086 EAST VIEW ROAD","city":"HAYES","state":"VA","zip":"23072-9998","dob":"1951-11-19","age":"","mstatus":"","insh":"900035969*01","cliId":"","pno":"804\/642-0046","cno":"","email":"","ename":"","eno":"","pphy":"VALLS, FRANCISCO X MD","ppno":"804\/693-2720","pcpadd":"STE 2200 7547 MEDICAL DRIVE","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":23061,"pcpcounty":"","pcpid":"","pcpname":"Internal Medicine Associates of Gloucester","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/594-0597","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","J44.9","J96.91","G47.33","J43.9","R26.9","F33.42","E78.2","G25.0","E55.9","E53.8","F41.9","F17.210","Z71.6","Z85.038","Z12.2","F17.200","J43.8","C78.00","I28.8","I31.3","R91.1","K59.09","I11.0","I50.9","M51.36","E78.5","F32.9","G89.29","Z79.899","Z79.51","Z80.1","Z91.040","Z88.0","C18.1","R91.8","J44.1","R79.89","K21.9","Z72.0","Z12.11","K63.5","F17.209","D12.5","D12.4","T20.20XA","J96.21","J96.22","J95.851","N39.0","R57.9","Z16.11","T17.590A","E11.9","T31.0","I48.0","Z86.74","B95.62","Z46.82","T30.0","Z97.8","J96.90","R40.2420","J15.212","I46.9","R45.1","Z93.0","R13.10","C18.2","R73.9","R10.84","R09.02","R21.","R97.0","I47.1","R00.1","I95.9","E87.6","R77.8","E83.42","I27.20","Z99.81","Z91.81","Z86.010","Z98.0","R60.9","R78.81","D72.829","Z48.00","I48.91","J98.9","B37.2","I36.1","Z88.3","Z91.02","R06.02","J96.00","Z45.2","R00.0","Z23.","M48.02","M47.816","M81.8","R32.","K58.9","D51.9","F33.41","C18.0","Z48.813","R79.1","Z90.710","R94.31","Z29.9","J96.01","I24.8","Z79.891","Z82.49","Z91.041","R06.00","I46.8","R40.2430","J98.8","X08.8XXA","I35.1","R07.9","J90.","T20.00XA","J41.0","J96.11","T20.20XS","F17.201","E61.1","R14.0","Z68.37","R29.6","Z85.41","Z08.","Z00.00","C34.90"],"date":["2021-11-27","2021-12-15","2021-12-15","2021-11-27","2021-11-27","2021-11-27","2020-04-21","2021-01-05","2020-04-21","2021-12-03","2021-12-03","2021-12-03","2021-10-27","2021-04-05","2021-06-16","2020-08-13","2021-06-30","2021-06-30","2020-08-13","2020-08-13","2020-08-13","2020-10-27","2020-10-27","2021-10-27","2021-10-27","2020-10-27","2021-12-03","2021-06-15","2020-10-27","2021-03-21","2021-03-21","2020-10-27","2021-06-15","2021-06-15","2020-10-29","2021-11-07","2021-06-15","2021-03-24","2021-03-24","2021-05-03","2021-06-15","2021-06-15","2021-06-15","2021-06-16","2021-06-16","2021-11-24","2021-11-04","2021-11-04","2021-10-27","2021-11-07","2021-10-27","2021-10-27","2021-10-27","2021-11-21","2021-11-27","2021-10-27","2021-10-27","2021-11-21","2021-11-06","2021-11-19","2021-11-03","2021-11-22","2021-11-05","2021-11-13","2021-11-19","2021-11-22","2021-11-24","2021-11-24","2021-05-03","2021-01-05","2020-10-05","2021-11-19","2021-05-03","2021-05-03","2021-11-09","2021-11-19","2021-11-19","2021-04-05","2021-03-21","2021-04-05","2021-12-03","2021-10-27","2021-05-10","2021-06-15","2021-06-15","2021-11-03","2021-11-21","2021-11-14","2021-11-07","2021-11-07","2020-10-28","2021-01-05","2021-04-22","2021-06-15","2021-06-15","2021-12-15","2021-11-06","2021-11-02","2021-11-21","2021-01-05","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2020-04-08","2021-03-23","2021-03-23","2021-04-27","2021-11-08","2021-11-22","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-11-02","2021-11-03","2021-11-05","2021-11-27","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-11-02","2019-10-08","2019-10-08","2020-11-02","2019-10-08","2021-01-05","2020-09-24"],"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":[["","62175061746","PANTOPRAZOLE SODIUM                                                   ","40MG","90","Select","Select",""],["","52244020010","THEO-24                                                               ","200MG CR","-30","Select","Select",""],["","68382000106","PAROXETINE HCL                                                        ","40MG","30","Select","Select",""],["","00603548332","PROPRANOLOL HYDROCHLORIDE                                             ","20MG","90","Select","Select",""],["","43547043009","FENOFIBRATE                                                           ","48MG","60","Select","Select",""],["","10702001801","OXYCODONE HYDROCHLORIDE                                               ","5MG","60","Select","Select",""],["","69097094312","GABAPENTIN                                                            ","300MG","60","Select","Select",""],["","00173085910","BREO ELLIPTA                                                          ","100-25","60","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","","8","Select","Select",""],["","50111044101","TRAZODONE HYDROCHLORIDE                                               ","150MG","30","Select","Select",""],["","43598075205","BUPROPION HYDROCHLORIDE ER (SR)                                       ","150MG SR","60","Select","Select",""],["","68382013905","TOPIRAMATE                                                            ","50MG","180","Select","Select",""],["","13811071910","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","100MG","14","Select","Select",""],["","00378115001","BUSPIRONE HYDROCHLORIDE                                               ","10MG","-90","Select","Select",""],["","45802008801","ALBUTEROL SULFATE HFA                                                 ","HFA","8","Select","Select",""],["","69452015120","VITAMIN D                                                             ","50000UNT","12","Select","Select",""],["","62332002531","THEOPHYLLINE ER                                                       ","300MG ER","-49","Select","Select",""],["","00085433301","ASMANEX HFA                                                           ","100 MCG","13","Select","Select",""],["","00093681673","BUDESONIDE                                                            ","0.5MG\/2","-60","Select","Select",""],["","63402091130","BROVANA                                                               ","15MCG","-120","Select","Select",""],["","00597015561","STIOLTO RESPIMAT                                                      ","2.5-2.5","-4","Select","Select",""],["","49502080693","YUPELRI                                                               ","","-90","Select","Select",""],["","00904530760","BANOPHEN                                                              ","50MG","1","Select","Select",""],["","47335070654","IPRATROPIUM BROMIDE                                                   ","0.02%INH","225","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT                                                      ","2.5MCG","-4","Select","Select",""],["","00527293537","PREDNISONE                                                            ","50MG","3","Select","Select",""],["","42543035260","NYSTATIN                                                              ","100000","-60","Select","Select",""],["","00832046560","NYAMYC                                                                ","100000","60","Select","Select",""],["","60258017101","MAGNESIUM OXIDE                                                       ","400MG","30","Select","Select",""],["","00536589588","NICOTINE TRANSDERMAL SYSTEM                                           ","14MG\/24H","28","Select","Select",""],["","70748025730","ARFORMOTEROL TARTRATE                                                 ","15\/2ML","120","Select","Select",""],["","76204060005","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE                                 ","ALBUTER","360","Select","Select",""],["","69452017173","AZITHROMYCIN                                                          ","250MG","-6","Select","Select",""],["","72140000022","EUCERIN                                                               ","","226","Select","Select",""],["","57664050658","METOPROLOL TARTRATE                                                   ","25MG","60","Select","Select",""],["","00143980350","DOXYCYCLINE HYCLATE                                                   ","100MG","20","Select","Select",""],["","69547035302","NARCAN                                                                ","","2","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":["",""]}},{"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":""}]}]}