{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SERITA F HOLT","gend":1,"add":"500 BIG FORREST CT APT 310","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1954-05-15","age":"","mstatus":"","insh":"900040125*01","cliId":"","pno":"757\/998-9658","cno":"","email":"","ename":"","eno":"","pphy":"MORIE, ZACHARY ALEXANDER DO","ppno":"757\/968-5700","pcpadd":"2855 DENBIGH BLVD STE A","pcpcity":"GRAFTON","pcpstate":"VA","pcpzip":23692,"pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E87.5","N17.9","E87.2","N39.0","Z74.1","R11.10","I48.0","E11.9","I10.","E78.5","J45.909","E66.9","I50.9","I27.0","R00.1","M62.81","N28.1","I21.4","R11.0","I25.2","I16.0","I48.91","E87.6","E83.42","I11.0","I50.32","E78.2","K02.9","Z79.01","D50.9","J43.9","E11.8","E66.01","Z68.41","D57.3","I45.2","F32.9","I07.1","I27.20","I49.5","M17.12","M25.562","R53.81","K80.20","R07.9","R79.89","Z79.84","E61.1","R23.8","H90.3","I08.8","R51.9","R90.82","R87.5","K21.9","I82.409","Z96.651","Z87.440","Z23.","I16.1","R07.2","I08.0","R53.1","Z74.3","R06.02","G45.9","R60.0","Z68.42","R09.89","R11.2","R03.0","I48.20","I08.1","I50.30","R77.8","Z60.2","Z86.73","Z90.710","I49.3","R94.31","I36.1","J45.20","R26.2","Z79.899","Z12.11"],"date":["2020-11-03","2021-03-01","2020-10-15","2020-10-01","2020-10-01","2021-03-02","2021-03-16","2021-04-25","2021-05-14","2021-04-25","2021-04-25","2020-10-15","2021-01-13","2020-10-01","2021-03-02","2020-10-15","2021-04-25","2021-03-02","2021-03-01","2021-03-16","2021-04-26","2021-04-26","2021-06-16","2021-04-26","2021-06-16","2021-10-08","2021-05-14","2021-05-14","2021-10-08","2021-05-14","2021-05-14","2021-10-08","2021-05-14","2021-05-14","2021-05-14","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-25","2020-10-06","2021-04-25","2021-04-25","2021-04-25","2021-06-16","2021-06-16","2021-06-16","2020-12-09","2020-12-21","2021-03-02","2021-03-01","2020-09-22","2020-12-17","2021-03-02","2021-04-25","2020-10-15","2020-11-03","2021-04-25","2021-04-24","2021-10-05","2020-09-22","2020-09-22","2020-09-23","2020-09-25","2020-12-17","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-04-25","2021-03-02","2021-04-25","2021-04-25","2021-04-25","2021-04-25","2021-03-01","2021-03-01","2020-09-23","2020-09-23","2020-09-29","2020-11-03","2020-12-27","2021-05-23"],"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":[["","53746051501","SPIRONOLACTONE ","100MG","-90","Select","Select",""],["","53885024510","ONETOUCH ULTRA ","ULTRA","100","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","00378001805","METOPROLOL TARTRATE ","25MG","60","Select","Select",""],["","31722052101","HYDRALAZINE HYDROCHLORIDE ","50MG","270","Select","Select",""],["","29300013601","CLONIDINE HYDROCHLORIDE ","0.2MG","270","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","90","Select","Select",""],["","63304071990","DILTIAZEM HYDROCHLORIDE ER ","180MG ER","90","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","30","Select","Select",""],["","68180037803","LOSARTAN POTASSIUM ","100MG","90","Select","Select",""],["","11917011540","VITAMIN D3 ","5000UNIT","100","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G ","PLUS 33G","-100","Select","Select",""],["","00378456105","POTASSIUM CHLORIDE ER ","10MEQ ER","30","Select","Select",""],["","00378718505","METFORMIN HYDROCHLORIDE ","500MG","-72","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA ","HFA","54","Select","Select",""],["","00603020922","MAGNESIUM OXIDE ","400MG","30","Select","Select",""],["","55111012305","ATORVASTATIN CALCIUM ","40MG","-56","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE ","160-4.5","31","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","90","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","-10","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE ","0.12%","-473","Select","Select",""],["","57237004105","PENICILLIN V POTASSIUM ","500MG","-28","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE ","5MG","30","Select","Select",""],["","68462016405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","65862050220","AMOXICILLIN\/CLAVULANATE POTASSIUM ","500-125","-10","Select","Select",""],["","00904759080","FEROSUL ","325MG","45","Select","Select",""],["","00597015230","JARDIANCE ","10MG","90","Select","Select",""],["","50111091701","TORSEMIDE ","20MG","-180","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE ","4MG","7","Select","Select",""],["","68585000575","MAG64 ","64MG","60","Select","Select",""],["","11917014382","LUBRICANT EYE DROPS ","0.5% OP","15","Select","Select",""],["","57237007710","ONDANSETRON ODT ","4MG ODT","20","Select","Select",""],["","11917009215","FERROUS SULFATE ","325MG","45","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":""}]}]}