{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GRACIELA NIEVES NAVARRO","gend":1,"add":"1366 KEATON WAY","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1948-04-20","age":"","mstatus":"","insh":"900040077*01","cliId":"","pno":"939\/206-0990","cno":"757\/600-9803","email":"","ename":"","eno":"","pphy":"HUSS, CAT NP","ppno":"757\/413-7600","pcpadd":"5320 PROVIDENCE RD STE 301","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-7601","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","F41.9","F33.1","I10.","M79.10","Z12.11","K21.9","R05.","M54.17","K59.00","J30.89","R39.15","R60.0","Z13.820","Z78.0","M54.9","Z87.828","Z82.62","E11.42","E11.21","E55.9","E03.9","E78.5","M54.42","R41.3","M54.41","G89.29","L60.0","M79.671","B35.1","I73.9","E11.51","M51.16","E11.9","Z88.5","M79.651","Z12.31","M81.0","M85.89","I67.82","J31.0","R80.9","Z68.31","M79.7","M19.90","Z76.89","K44.9","Z20.822","E11.69","M85.80","E66.9","F32.9","R79.9","R89.9","M54.5","M25.511","M62.838","I12.9","E11.36","E11.22","L82.0","L82.1","L70.0","Z71.9","M25.473","M79.672","N18.2","E66.3","M47.27","M25.512","M86.8X8","M25.552","M51.36","M47.817","M54.16","Z11.59","M18.2"],"date":["2020-10-02","2021-06-25","2021-09-24","2021-09-04","2021-03-19","2021-05-23","2021-09-24","2021-07-23","2021-10-28","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-08-16","2021-08-16","2021-08-16","2021-09-24","2021-09-24","2021-08-16","2021-09-07","2021-08-16","2021-08-17","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-09-24","2021-10-16","2021-09-04","2021-09-04","2021-09-04","2020-10-06","2021-09-24","2020-10-06","2021-09-07","2020-11-19","2020-11-19","2020-11-19","2021-03-04","2021-07-22","2021-03-04","2021-06-29","2021-08-21","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-09-24","2021-09-24","2021-09-24","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-26","2021-03-03","2021-07-22","2021-07-22","2021-09-29","2021-03-09","2021-08-19","2021-08-19","2021-09-04","2021-09-29","2021-11-09","2020-11-11","2021-07-17"],"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":[["","53885024510","ONETOUCH ULTRA                                                        ","ULTRA","100","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G                           ","PLUS 33G","100","Select","Select",""],["","70377000315","SIMVASTATIN                                                           ","20MG","90","Select","Select",""],["","00093820401","CIMETIDINE                                                            ","400MG","60","Select","Select",""],["","68462018135","CLOTRIMAZOLE                                                          ","1%","60","Select","Select",""],["","16729044315","BUPROPION HYDROCHLORIDE ER (XL)                                       ","150MG XL","-30","Select","Select",""],["","33342004910","IRBESARTAN                                                            ","300MG","-90","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE                                                   ","10MG","90","Select","Select",""],["","00005197102","PREVNAR 13                                                            ","","0","Select","Select",""],["","64380071306","BENZONATATE                                                           ","200MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","50MCG","-16","Select","Select",""],["","11917007552","CALCIUM 600 HIGH POTENCY                                              ","600MG","90","Select","Select",""],["","00591272060","METFORMIN HYDROCHLORIDE ER                                            ","1000MG","30","Select","Select",""],["","70461032003","FLUCELVAX QUADRIVALENT 2020-2021                                      ","2020-21","0","Select","Select",""],["","00363876020","SENNA-S                                                               ","8.6-50MG","90","Select","Select",""],["","00904530660","BANOPHEN                                                              ","25MG","90","Select","Select",""],["","31604001870","VITAMIN D                                                             ","1000UNIT","90","Select","Select",""],["","00536124801","STIMULANT LAXATIVE                                                    ","8.6-50MG","60","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM                                                  ","50MCG","90","Select","Select",""],["","55111032201","GLIMEPIRIDE                                                           ","4MG","-180","Select","Select",""],["","00121077504","GUAIFENESIN\/CODEINE                                                   ","100-10\/5","118","Select","Select",""],["","69238117009","DOXEPIN HYDROCHLORIDE                                                 ","25MG","90","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE                                                   ","25MG","90","Select","Select",""],["","70010075401","METHOCARBAMOL                                                         ","500MG","120","Select","Select",""],["","68682010110","PENTOXIFYLLINE ER                                                     ","400MG ER","270","Select","Select",""],["","45802014167","CICLOPIROX NAIL LACQUER                                               ","8%","7","Select","Select",""],["","59762374301","CLINDAMYCIN PHOSPHATE                                                 ","1%","30","Select","Select",""],["","53885014301","ONETOUCH DELICA LANCETS EXTRA FINE 33G                                ","LANCETS","-100","Select","Select",""],["","00781808926","AZITHROMYCIN                                                          ","250MG","6","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","HFA","8","Select","Select",""],["","12843003520","PHILLIPS STOOL SOFTENER                                               ","100MG","30","Select","Select",""],["","65162063609","PANTOPRAZOLE SODIUM                                                   ","20MG","30","Select","Select",""],["","59267100001","PFIZER-BIONTECH COVID-19 VACCINE                                      ","COVID-19","0","Select","Select",""],["","65162037110","OXYBUTYNIN CHLORIDE ER                                                ","5MG ER","-30","Select","Select",""],["","72305005030","EUTHYROX                                                              ","50MCG","90","Select","Select",""],["","43547040111","FUROSEMIDE                                                            ","20MG","14","Select","Select",""],["","16714063301","ALENDRONATE SODIUM                                                    ","70MG","-12","Select","Select",""],["","16571040250","CETIRIZINE HYDROCHLORIDE                                              ","10MG","30","Select","Select",""],["","65862086099","FAMOTIDINE                                                            ","40MG","90","Select","Select",""],["","59746017509","PREDNISONE                                                            ","20MG","-8","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","5-325MG","-12","Select","Select",""],["","49281012165","FLUZONE HIGH-DOSE PF 2021-2022                                        ","2021-22","1","Select","Select",""],["","52817031910","BACLOFEN                                                              ","5MG","90","Select","Select",""],["","58160082311","SHINGRIX                                                              ","50\/0.5ML","1","Select","Select",""],["","00006483703","PNEUMOVAX 23                                                          ","25\/0.5","0","Select","Select",""],["","62332012190","PREGABALIN                                                            ","75MG","60","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":""}]}]}