{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN W RICE","gend":0,"add":"112 MYWAY LN","city":"WHITE STONE","state":"VA","zip":"22578-9998","dob":"1955-08-29","age":"","mstatus":"","insh":"900040027*01","cliId":"","pno":"804\/435-6978","cno":"","email":"","ename":"","eno":"","pphy":"STONE, JESSICA NP","ppno":"804\/435-2651","pcpadd":"402 NORTH MAIN STREET","pcpcity":"KILMARNOCK","pcpstate":"VA","pcpzip":22482,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS KILMARNOCK PRIMARY CARE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/435-2303","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I73.9","E16.2","R40.20","R11.2","R41.82","R47.02","R45.1","I21.3","I21.02","E08.42","Z95.1","I70.202","I25.10","Z09.","Z68.28","Z98.61","I48.0","I50.42","I25.5","I63.9","E11.21","Z89.512","I16.1","J96.01","I50.21","N17.9","J81.0","I50.43","I10.","E78.2","E11.42","J96.02","Z79.4","Z68.27","I48.20","I50.20","E11.51","I70.211","Z98.62","I70.219","I65.23","I77.1","I50.9","D69.6","Z86.73","I71.4","R45.4","N18.30","Z68.26","R11.10","Z95.820","Z87.891","R07.9","J81.1","J90.","K52.9","I25.709","I63.89","I50.23","R47.01","I11.0","E78.00","F32.9","F41.9","I51.7","I35.8","Z03.89","Z20.822","R06.03","D72.829","A41.9","J18.9","E87.2","E66.3","N20.0","I16.0","R06.02","Z12.11","Z68.25","Z01.810","I87.2","Z79.01","R25.1","R00.1","E78.5","R07.89","R00.0","I49.3","R94.31","E11.40","I25.2","I50.22","Z87.442","F34.1","R69.","Z79.899","T50.905A","Z00.00","I70.90"],"date":["2021-10-07","2020-12-23","2020-12-23","2021-04-11","2021-04-14","2021-04-11","2021-04-12","2021-04-14","2021-06-16","2021-04-16","2021-09-20","2021-04-16","2021-09-20","2021-05-03","2021-06-03","2021-09-20","2021-10-07","2021-06-30","2021-09-20","2021-06-16","2021-09-20","2021-07-15","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-09-20","2021-09-28","2021-10-07","2021-10-07","2021-06-08","2021-10-07","2021-06-21","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-09-14","2021-09-14","2021-04-13","2021-05-26","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-04-11","2021-04-21","2021-06-05","2021-06-05","2021-06-06","2021-06-05","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-13","2021-06-16","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-06-05","2021-06-05","2021-04-14","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2021-05-23","2021-04-13","2021-04-13","2021-06-03","2021-06-21","2021-06-21","2021-06-30","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-05-28","2021-05-28","2021-05-28","2021-06-30","2020-11-10","2020-11-10"],"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":[["","65162010250","GABAPENTIN ","300MG","180","Select","Select",""],["","00536100836","ASPIRIN ","81MG","90","Select","Select",""],["","00006027731","JANUVIA ","100MG","30","Select","Select",""],["","00378001805","METOPROLOL TARTRATE ","25MG","-30","Select","Select",""],["","08290320109","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM ","31GX8MM","100","Select","Select",""],["","31722070210","LOSARTAN POTASSIUM ","100MG","-90","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCETS FINE 30G ","PLUS 30G","100","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS ","VERIO","100","Select","Select",""],["","55111012205","ATORVASTATIN CALCIUM ","20MG","90","Select","Select",""],["","70461012003","FLUAD QUADRIVALENT INFLUENZA VACCINE FOR ADULTS ","0.5ML","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00169643810","LEVEMIR FLEXTOUCH ","FLEXTOUC","15","Select","Select",""],["","53885027302","ONETOUCH VERIO MID CONTROL SOLUTION ","VERIO","-1","Select","Select",""],["","00363021879","ASPIRIN 81 LOW DOSE ","81MG","90","Select","Select",""],["","11917010927","GLUCOSE ","40%","114","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90","Select","Select",""],["","62037099901","POTASSIUM CHLORIDE ER ","20MEQ ER","60","Select","Select",""],["","62037071001","POTASSIUM CHLORIDE CR ","10MEQ CR","30","Select","Select",""],["","65862035705","CLOPIDOGREL ","75MG","90","Select","Select",""],["","65862073260","AMIODARONE HYDROCHLORIDE ","200MG","90","Select","Select",""],["","00003089321","ELIQUIS ","2.5MG","180","Select","Select",""],["","27241009803","DULOXETINE HCL ","30MG","-30","Select","Select",""],["","00378668899","PANTOPRAZOLE SODIUM ","20MG","90","Select","Select",""],["","70461012103","FLUAD QUADRIVALENT 2021-2022 ","2021-22","0","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":""}]}]}