{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DORIS   A SIMMONS","gend":1,"add":"3908 BOB WHITE BLVD APT C","city":"PULASKI","state":"VA","zip":"24301-9998","dob":"1942-03-27","age":"","mstatus":"","insh":"900039873*01","cliId":"","pno":"540\/440-8318","cno":"540\/418-2758","email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO MD","ppno":"540\/769-3964","pcpadd":"5115 BERNARD DR STE 301","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSAL HEALTH CORPORATION","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/473-3458","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L89.153","I99.8","L02.415","L89.623","Z48.00","E11.40","S21.201D","I73.9","E11.65","E11.51","E11.621","L97.419","I51.7","I51.9","L03.115","L97.519","L97.529","N18.3","E11.9","Z79.4","I10.","K21.9","I96.","L89.159","B37.2","Z89.411","T81.89XA","N17.9","E11.649","Z86.73","F32.9","F03.90","N32.81","L89.603","L89.152","S81.812D","L89.312","L89.322","S71.011D","L90.9","R52.","N28.9","R23.9","Z89.429","Z91.89","R60.0","S71.001D","Z87.2","R41.82","R53.1","S31.819A","N39.0","L89.319","L89.310","B95.7","Z48.817","B95.61","L89.621","L89.151","L89.610","I50.9","G30.9","M62.81","R26.89","R41.841","F02.80","Z86.14","F41.9","L97.522","M86.9","M86.172","E11.69","E11.42","L97.528","E11.22","M86.8X7","I12.9","N18.9","L89.311","L89.611","N18.30","G89.29","D64.9","G62.9","R29.898","E55.9","L89.214","L89.612","L89.622","S72.402A","S72.012A","S72.045A","N18.32","S73.005A","Z96.649","L98.9","M19.90","I25.10","E78.5","E11.8","Z89.421","R09.89","I44.0","R94.31","R53.81","R10.9","T81.82XA","F33.1","R41.89","L89.224","L97.526","S91.105A","L02.612","S72.002A","W19.XXXA","S72.009A","S81.801A","Z98.890","T84.021A","Z20.822","D62.","E44.0","M00.9","F32.A","Z79.82","Z79.84","E08.621","E08.65","R60.9","M60.08","B95.2","R31.9","M10.30","Z89.412","Z01.812","Z89.422","M86.272","E11.52","L97.929","L03.116","Z99.3","I83.90","S31.000A","M77.32","Z89.022","M89.8X7","E08.40","M15.0","M81.0","Z88.1","Z88.5","Z88.2","Z88.8","Z79.899","R21.","R15.9","N39.41","L22.","R94.5","T14.8XXA","E11.628","L08.9","L97.521","M24.452","H05.029","L02.611","R10.2","L89.302","N30.01","R41.0","E87.6","L89.620","D51.9","L97.909","R93.89","Z89.021","L30.8","T84.52XA","I63.9","L89.150","L97.409","L97.429","Z23.","R54.","I95.9","Z47.89","T79.7XXA","D72.829","R79.82","S91.302D","S91.301A"],"date":["2020-10-24","2020-08-17","2020-08-17","2020-10-24","2020-08-12","2021-11-07","2021-03-15","2021-09-06","2021-11-28","2021-11-07","2021-12-13","2020-09-02","2020-09-03","2020-09-03","2021-08-24","2021-08-30","2021-11-07","2020-09-10","2021-12-13","2021-11-28","2021-12-14","2021-12-13","2020-10-14","2020-10-25","2020-12-14","2020-09-22","2020-10-28","2020-11-17","2020-10-25","2021-12-13","2021-11-07","2021-12-13","2021-09-30","2020-10-25","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-09-30","2020-12-18","2021-09-30","2021-09-30","2021-09-30","2020-12-18","2021-09-30","2021-03-10","2021-01-04","2021-01-27","2021-12-13","2021-08-24","2021-11-28","2021-12-13","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-08-24","2021-05-11","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-11-28","2021-07-01","2021-08-31","2021-07-05","2021-08-30","2021-07-05","2021-07-05","2021-11-28","2021-08-30","2021-11-28","2021-07-05","2021-07-10","2021-07-10","2021-11-07","2021-11-07","2021-12-13","2021-09-30","2021-09-30","2021-09-30","2021-11-07","2021-11-07","2021-11-07","2021-11-08","2021-11-08","2021-11-12","2021-11-28","2021-11-13","2021-11-13","2021-11-14","2021-11-14","2021-12-14","2021-09-06","2021-03-01","2021-03-01","2020-12-18","2021-01-27","2021-01-27","2021-05-12","2021-03-13","2021-03-13","2021-04-12","2021-04-12","2021-05-12","2021-07-01","2021-07-05","2021-08-13","2021-11-07","2021-11-07","2021-12-13","2021-12-13","2021-12-13","2021-11-30","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2020-09-02","2020-09-02","2020-09-02","2020-10-24","2020-10-24","2020-11-17","2020-11-17","2021-03-01","2021-07-01","2021-08-30","2021-09-06","2020-09-03","2020-09-03","2021-08-30","2020-09-03","2020-09-03","2021-01-27","2021-08-11","2021-08-26","2021-08-24","2021-10-04","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2020-09-08","2020-09-25","2020-09-25","2020-09-25","2021-03-15","2021-08-24","2021-09-06","2021-09-06","2021-10-04","2021-11-28","2021-12-22","2020-09-03","2020-10-25","2020-11-06","2021-01-27","2021-01-27","2021-03-15","2021-04-28","2021-05-13","2021-08-26","2021-08-26","2021-08-26","2021-11-12","2021-12-09","2021-12-13","2020-10-14","2021-03-25","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-12-17","2021-03-14","2021-03-14","2021-03-14","2021-08-24","2021-08-24"],"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":[["","65862018601","CLINDAMYCIN HCL                                                       ","300MG","30","Select","Select",""],["","00781185220","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","20","Select","Select",""],["","62332012690","PREGABALIN                                                            ","300MG","28","Select","Select",""],["","65862001205","SERTRALINE HCL                                                        ","50MG","60","Select","Select",""],["","08290320122","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM                              ","32GX4MM","200","Select","Select",""],["","65862006201","METOPROLOL TARTRATE                                                   ","25MG","90","Select","Select",""],["","00143980350","DOXYCYCLINE HYCLATE                                                   ","100MG","14","Select","Select",""],["","31722072320","LEVOFLOXACIN                                                          ","750MG","7","Select","Select",""],["","62175013643","OMEPRAZOLE                                                            ","40MG","30","Select","Select",""],["","00597014030","TRADJENTA                                                             ","5MG","30","Select","Select",""],["","68180046901","LOVASTATIN                                                            ","40MG","30","Select","Select",""],["","00002879959","HUMALOG KWIKPEN                                                       ","100\/ML","15","Select","Select",""],["","00904759160","FERROUS SULFATE                                                       ","325MG","30","Select","Select",""],["","00169643810","LEVEMIR FLEXTOUCH                                                     ","FLEXTOUC","15","Select","Select",""],["","00002143480","TRULICITY                                                             ","1.5\/0.5","6","Select","Select",""],["","68382039801","POTASSIUM CHLORIDE ER                                                 ","20MEQ ER","30","Select","Select",""],["","00597015330","JARDIANCE                                                             ","25MG","-30","Select","Select",""],["","29300017116","MEMANTINE HYDROCHLORIDE                                               ","HCL 5MG","30","Select","Select",""],["","70377000911","ROSUVASTATIN CALCIUM                                                  ","40MG","30","Select","Select",""],["","43547040110","FUROSEMIDE                                                            ","20MG","30","Select","Select",""],["","00469260230","MYRBETRIQ                                                             ","50MG","90","Select","Select",""],["","68462010340","FLUCONAZOLE                                                           ","150MG","-2","Select","Select",""],["","68180012202","CEPHALEXIN                                                            ","500MG","10","Select","Select",""],["","51224002218","AZITHROMYCIN                                                          ","250MG","6","Select","Select",""],["","96095000211","                                                                      ","","30","Select","Select",""],["","16714040001","CEFUROXIME AXETIL                                                     ","250MG","14","Select","Select",""],["","65162062711","TRAMADOL HCL                                                          ","50MG","-29","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","100\/ML","3","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN                                                       ","FLEXPEN","3","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN                                                ","FLEXPEN","3","Select","Select",""],["","00169413602","OZEMPIC                                                               ","2\/1.5ML","2","Select","Select",""],["","00904759160","FEROSUL                                                               ","325MG","30","Select","Select",""],["","00406012301","HYDROCODONE\/ACETAMINOPHEN                                             ","5-325MG","5","Select","Select",""],["","70710112307","DOXYCYCLINE MONOHYDRATE                                               ","100MG","-14","Select","Select",""],["","65862018601","CLINDAMYCIN HYDROCHLORIDE                                             ","300MG","30","Select","Select",""],["","16714000610","ENOXAPARIN SODIUM                                                     ","30\/0.3ML","3","Select","Select",""],["","37864000150","CALCIUM ANTACID                                                       ","500MG","150","Select","Select",""],["","49348097310","SM PAIN RELIEVER                                                      ","325MG","30","Select","Select",""],["","49100040038","CULTURELLE PRO-WELL                                                   ","PRO-WELL","60","Select","Select",""],["","00409651001","VANCOMYCIN HCL                                                        ","10GM","1","Select","Select",""],["","70594005702","VANCOMYCIN HYDROCHLORIDE                                              ","1.25GM","250","Select","Select",""],["","00093342201","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","10MG","20","Select","Select",""],["","43386035610","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","5-325MG","30","Select","Select",""],["","00904699860","DOCUSATE SODIUM                                                       ","100MG","20","Select","Select",""],["","16714076901","NYSTATIN                                                              ","100000","-15","Select","Select",""],["","08290306546","NORMAL SALINE FLUSH                                                   ","0.90%","40","Select","Select",""],["","00536120473","MENTHOL ZINC                                                          ","0.45-20%","113","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":""}]}]}