{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY   A KIRK","gend":1,"add":"161 D VIEW AVE APT 3","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1961-04-01","age":"","mstatus":"","insh":"900038021*01","cliId":"","pno":"757\/701-4231","cno":"","email":"","ename":"","eno":"","pphy":"BUMANGLAG, LEILA MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LN SUITE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","R30.0","S20.211A","Z79.51","Z79.899","I10.","J45.909","K21.9","Z87.891","R07.81","R52.","Z74.3","K42.9","S22.070A","S22.39XA","M25.512","M25.511","R35.0","E66.9","Z68.41","M79.18","Z88.0","Z87.09","Z86.69","W19.XXXA","T14.90XA","R07.9","G40.89","M54.5","F70.","E53.8","W01.198A","D50.9","Z12.11","D75.89","R74.8","K22.10","Z00.00","Z12.31","J45.41","Z68.33","E78.00","E55.9","N30.90","R10.0","R19.7","L08.9","J43.8","J30.1","K27.9","R56.9","D50.8","M81.0","R68.89"],"date":["2020-06-09","2021-05-25","2020-07-24","2020-07-24","2020-07-24","2021-09-16","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-06-09","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2020-07-24","2020-01-28","2020-01-28","2020-01-28","2021-09-16","2020-07-23","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-03-16","2021-09-16","2021-09-16","2021-03-16","2021-09-16","2021-03-16","2020-06-09","2021-05-25","2021-05-25","2021-05-25","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16"],"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":[["","00904582460","VITAMIN D3                                                            ","1000UNIT","30","Select","Select",""],["","29300022705","METRONIDAZOLE                                                         ","500MG","14","Select","Select",""],["","16714068502","SIMVASTATIN                                                           ","80MG","30","Select","Select",""],["","42806016001","HYDROXYZINE HYDROCHLORIDE                                             ","25MG","60","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","","8","Select","Select",""],["","51672400501","CARBAMAZEPINE                                                         ","200MG","150","Select","Select",""],["","68180051801","LISINOPRIL\/HYDROCHLOROTHIAZIDE                                        ","10-12.5","90","Select","Select",""],["","68462013001","ZONISAMIDE                                                            ","100MG","90","Select","Select",""],["","68382009205","CARVEDILOL                                                            ","3.125MG","180","Select","Select",""],["","66993058597","FLUTICASONE PROPIONATE\/SALMETEROL DISKUS                              ","250\/50","60","Select","Select",""],["","52569014184","                                                                      ","","180","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","HFA","18","Select","Select",""],["","11917017252","VITAMIN B12                                                           ","1000MCG","180","Select","Select",""],["","16714074703","OMEPRAZOLE                                                            ","20MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","","18","Select","Select",""],["","31722055190","LEVOCETIRIZINE DIHYDROCHLORIDE                                        ","5MG","90","Select","Select",""],["","00005197102","PREVNAR 13                                                            ","","0","Select","Select",""],["","58160088552","FLUARIX QUADRIVALENT 2020-2021                                        ","2020-21","0","Select","Select",""],["","10939050344","SM VITAMIN B12 TR                                                     ","2000MCG","90","Select","Select",""],["","31722072610","MONTELUKAST SODIUM                                                    ","10MG","90","Select","Select",""],["","10135065201","B-12                                                                  ","1000MCG","180","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE                                              ","COVID-19","0","Select","Select",""],["","62011015703","HM OMEPRAZOLE                                                         ","20MG","30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","1%","200","Select","Select",""],["","58160088752","FLUARIX QUADRIVALENT 2021-2022                                        ","2021-22","0","Select","Select",""],["","74312001380","VITAMIN B-12                                                          ","1000MCG","180","Select","Select",""],["","68752064098","CALCIUM CARBONATE\/VITAMIN D                                           ","\/VIT D","180","Select","Select",""],["","00173069700","ADVAIR DISKUS                                                         ","500\/50","180","Select","Select",""],["","00054001925","PREDNISONE                                                            ","50MG","5","Select","Select",""],["","00173089310","TRELEGY ELLIPTA                                                       ","ELLIPTA","180","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":""}]}]}