{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNICE S DABNEY","gend":1,"add":"336 JENKINS CHURCH RD","city":"CUMBERLAND","state":"VA","zip":"23040-9998","dob":"1952-08-18","age":"","mstatus":"","insh":"900042630*01","cliId":"","pno":"804\/887-0132","cno":"","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T MD","ppno":"434\/581-3271","pcpadd":"RT 15 SOUTH","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/581-1105","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","I50.33","I82.90","E66.01","G47.30","Z71.89","Z71.3","L02.91","K80.20","N17.9","M47.12","G95.20","H69.83","K42.9","Z12.11","D12.3","D12.5","K64.1","Z98.0","Z85.038","Z86.010","I13.0","E11.22","Z79.4","N18.30","I50.9","E78.5","E07.9","J44.9","G47.33","M19.90","K63.5","R60.9","R22.2","E11.9","A41.9","G95.9","Z98.1","M54.40","R74.8","Z23.","G47.34","K43.9","H26.9","I82.401","R06.02","R60.0","Z87.891","Z79.899","I11.0","R06.83","G47.10","E11.3512","H61.22","M25.552","E11.3593","N18.31","L72.0","M25.511","E11.3513","N18.9","I50.32","G47.36","E03.9","E11.36","M10.9","Z68.43","Z09.","G89.29","M53.3","E10.9","R19.5","I42.9","D64.9","Z79.84","R79.89","M47.816","M54.5","D12.6","Z78.9"],"date":["2021-11-22","2021-03-31","2021-03-31","2021-08-25","2021-03-31","2021-07-28","2021-07-28","2021-01-11","2021-03-05","2021-03-31","2021-05-28","2021-05-28","2021-07-28","2021-12-18","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-25","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-12-20","2021-08-13","2021-08-25","2021-03-16","2021-12-18","2021-11-22","2021-03-04","2021-09-08","2021-09-08","2021-04-27","2021-04-27","2021-02-20","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-12","2021-03-12","2021-04-27","2021-04-27","2021-03-31","2021-05-01","2021-05-01","2021-06-25","2021-06-23","2021-06-29","2021-07-30","2021-11-22","2021-02-25","2021-09-08","2021-09-24","2021-12-18","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-25","2021-05-04","2021-04-22","2021-04-22","2021-05-26","2021-01-19","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-04-26","2021-04-27","2021-08-13","2021-01-26"],"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":[["","60505014101","GLIPIZIDE ","5MG","30","Select","Select",""],["","68180096701","LEVOTHYROXINE SODIUM ","75MCG","30","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM ","100MG","30","Select","Select",""],["","00832532515","POTASSIUM CHLORIDE ER ","20MEQ ER","60","Select","Select",""],["","00054007725","TORSEMIDE ","20MG","-60","Select","Select",""],["","67877022305","GABAPENTIN ","300MG","90","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN ","FLEXPEN","15","Select","Select",""],["","55111072910","ALLOPURINOL ","100MG","30","Select","Select",""],["","43547040210","FUROSEMIDE ","40MG","60","Select","Select",""],["","60505100302","KETOROLAC TROMETHAMINE ","0.50%","10","Select","Select",""],["","57599000101","FREESTYLE LIBRE 14 DAY\/SENSOR\/FLASH MONITORING SYSTEM ","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM ","READER","1","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","60","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM ","20MG","30","Select","Select",""],["","50458058030","XARELTO ","10MG","30","Select","Select",""],["","69097012715","AMLODIPINE BESYLATE ","5MG","30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM ","1%","100","Select","Select",""],["","00169266015","TRESIBA FLEXTOUCH ","100UNIT","15","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","10702000601","CYCLOBENZAPRINE HYDROCHLORIDE ","5MG","30","Select","Select",""],["","68382066010","SPIRONOLACTONE ","25MG","30","Select","Select",""],["","08214385034","LEADER UNIFINE PENTIPS PLUS\/MINI\/31GX3\/16\" ","31GX3\/16","100","Select","Select",""],["","00169430713","RYBELSUS ","7MG","30","Select","Select",""],["","51672131200","MUPIROCIN ","2%","22","Select","Select",""],["","51660052605","ALLERGY RELIEF ","10MG","8","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE ","50MCG","16","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS ","800-160","14","Select","Select",""],["","17478071511","BRIMONIDINE TARTRATE ","0.2% OP","10","Select","Select",""],["","61314063705","PREDNISOLONE ACETATE ","1% OP","10","Select","Select",""],["","00310621030","FARXIGA ","10MG","30","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":""}]}]}