{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY   L JORDAN","gend":1,"add":"2114 WILLOW WOOD DR","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1952-02-15","age":"","mstatus":"","insh":"900042027*01","cliId":"","pno":"757\/404-4894","cno":"","email":"","ename":"","eno":"","pphy":"ELLISON, TRACI H PA","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS GHENT STATION MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I11.9","R06.00","G47.33","E78.5","F17.210","H40.053","H26.491","E11.8","E11.65","J44.9","K21.9","G47.30","E66.01","F17.200","E03.9","D50.9","Z00.00","I10.","E11.22","Z68.39","Z87.891","N18.32","M06.9","G89.4","Z79.4","G43.909","E55.9","N18.30","Z02.89","N63.25","S80.212A","L08.9","M05.741","Z79.899","D50.0","D56.3","N25.81","I12.9","R80.9","J01.90","E11.42","Z68.41","M1A.09X1","M15.0","E11.9","J43.8","R79.89","Z01.818","Z12.31","N64.89","E78.00","D63.1","R74.01","M81.0","N63.0","H01.111","H01.112","H01.114","H01.115","D24.2","E07.9","E11.69","M10.9","R22.40","N63.20","R92.8","H10.45"],"date":["2021-11-23","2021-06-28","2021-12-01","2021-11-23","2021-09-16","2021-11-24","2021-05-17","2021-04-28","2021-08-30","2021-11-12","2021-08-13","2021-11-12","2021-11-12","2021-08-30","2021-08-30","2021-10-11","2021-10-14","2021-12-08","2021-12-09","2021-10-14","2021-10-14","2021-12-09","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-11-23","2021-09-16","2021-07-07","2021-07-06","2021-09-16","2021-09-16","2021-10-11","2021-10-11","2021-10-18","2021-10-18","2021-11-29","2021-12-09","2021-12-09","2021-02-08","2021-04-12","2021-04-12","2021-09-16","2021-09-16","2021-12-08","2021-09-16","2021-09-16","2021-12-08","2021-06-28","2021-07-01","2021-02-16","2021-04-19","2021-07-14","2021-07-14","2021-07-14","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-07-08","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-07-06","2021-07-06","2021-08-02"],"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":[["","00002418230","OLUMIANT                                                              ","2MG","-30","Select","Select",""],["","08290309625","1ML TUBERCULIN SYRINGE DETACHABLE NEEDLE SLIP TIP 26GX3\/8\"            ","26GX3\/8\"","12","Select","Select",""],["","16714063301","ALENDRONATE SODIUM                                                    ","70MG","12","Select","Select",""],["","64764017590","DEXILANT                                                              ","60MG DR","90","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN                                               ","5-325MG","60","Select","Select",""],["","67877019705","AMLODIPINE BESYLATE                                                   ","2.5MG","-90","Select","Select",""],["","00186037020","SYMBICORT                                                             ","160-4.5","31","Select","Select",""],["","08290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"                                ","32GX5\/32","100","Select","Select",""],["","64380073706","VITAMIN D                                                             ","50000UNT","13","Select","Select",""],["","00591555601","PROPRANOLOL HCL                                                       ","40MG","180","Select","Select",""],["","00143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","20","Select","Select",""],["","00310009530","DALIRESP                                                              ","500MCG","-30","Select","Select",""],["","00002143480","TRULICITY                                                             ","1.5\/0.5","6","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","100\/ML","33","Select","Select",""],["","65162071009","COLCHICINE                                                            ","0.6MG","-180","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER                                                    ","HANDIHLR","90","Select","Select",""],["","16729013401","ALLOPURINOL                                                           ","100MG","180","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE                              ","160-4.5","-10","Select","Select",""],["","31722083030","ARIPIPRAZOLE                                                          ","30MG","90","Select","Select",""],["","00185111160","BUPROPION HYDROCHLORIDE ER (SR)                                       ","200MG SR","180","Select","Select",""],["","69238149001","BUMETANIDE                                                            ","1MG","90","Select","Select",""],["","65862019430","FLUOXETINE HYDROCHLORIDE                                              ","40MG","180","Select","Select",""],["","31722070090","LOSARTAN POTASSIUM                                                    ","25MG","90","Select","Select",""],["","00378537501","DOXEPIN HCL                                                           ","75MG","90","Select","Select",""],["","27808015601","ROSUVASTATIN CALCIUM                                                  ","10MG","90","Select","Select",""],["","68180097001","LEVOTHYROXINE SODIUM                                                  ","112MCG","90","Select","Select",""],["","61314054701","LATANOPROST                                                           ","0.01%","8","Select","Select",""],["","65862086001","FAMOTIDINE                                                            ","40MG","180","Select","Select",""],["","68180033801","METFORMIN HYDROCHLORIDE ER                                            ","500MG ER","30","Select","Select",""],["","99073013001","FREESTYLE LANCETS                                                     ","LANCETS","60","Select","Select",""],["","00185061501","HYDROXYZINE PAMOATE                                                   ","50MG","90","Select","Select",""],["","69315012701","FOLIC ACID                                                            ","1000MCG","90","Select","Select",""],["","99073070827","FREESTYLE LITE TEST STRIPS                                            ","LITE","100","Select","Select",""],["","61703035038","METHOTREXATE SODIUM                                                   ","25MG\/ML","12","Select","Select",""],["","61314012605","KETOROLAC TROMETHAMINE                                                ","0.50%","5","Select","Select",""],["","99073070805","FREESTYLE LITE BLOOD GLUCOSE MONITORING SYSTEM                        ","LITE","1","Select","Select",""],["","62332050606","AZELASTINE HYDROCHLORIDE                                              ","0.05%","6","Select","Select",""],["","08290305539","1ML ALLERGIST TRAY INTRADERMAL BEVEL 26GX3\/8\"                         ","TRAY SYR","12","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","","8","Select","Select",""],["","69238115403","EZETIMIBE                                                             ","10MG","90","Select","Select",""],["","67877022005","CEPHALEXIN                                                            ","250MG","40","Select","Select",""],["","70461012103","FLUAD QUADRIVALENT 2021-2022                                          ","2021-22","0","Select","Select",""],["","50383023310","DORZOLAMIDE HCL\/TIMOLOL MALEATE                                       ","22.3-6.8","10","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA                                                 ","HFA","7","Select","Select",""],["","55111064501","OMEPRAZOLE                                                            ","40MG","90","Select","Select",""],["","08489831510","DROPLET PEN NEEDLES 32GX4MM                                           ","32GX4MM","100","Select","Select",""],["","10135015461","BISACODYL EC                                                          ","5MG EC","4","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL 3350                                              ","3350 NF","238","Select","Select",""],["","11822029233","RA LAXATIVE                                                           ","5MG EC","4","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":""}]}]}