{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SISTER   M PIUS SHORTALL","gend":1,"add":"5500 HOLLY FORK RD","city":"BARHAMSVILLE","state":"VA","zip":"23011-9998","dob":"1938-05-01","age":"","mstatus":"","insh":"900045990*01","cliId":"","pno":"757\/566-1684","cno":"","email":"","ename":"","eno":"","pphy":"VITERBO NOBLE, ELENA MD","ppno":"757\/564-3700","pcpadd":"STE 405 7151 RICHMOND RD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"NORGE FAMILY MEDICINE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/564-8515","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K81.0","E55.9","E78.00","R73.9","E87.6","I11.0","I50.21","G40.909","F01.50","R78.81","I80.9","I48.0","F03.90","R74.01","K92.0","K92.2","I63.9","R41.89","J47.1","M41.20","J47.9","N32.81","I10.","Z00.00","M85.9","H40.9","D64.9","M81.0","H40.1231","H54.7","I69.398","H35.372","S82.135A","M23.304","R22.42","M22.42","M25.562","Z86.73","R41.3","R56.9","K27.9","K59.00","M79.671","S82.155D","M17.11","M25.571","M17.12","S93.401A","D62.","K92.1","R94.5","K25.9","K29.60","M79.662","N39.0","R33.9","R35.0","I50.42","D72.19","Z13.820","K25.7","I48.20","K22.70","E78.5","J44.9","M17.0","J45.30","Z90.49","Z85.038","Z87.891","M17.9","Z68.23","J96.01","J98.11","M84.362A","Z23.","Z68.21","M72.2","M76.821","M76.61","S92.141D","M25.572","Z71.3","R53.1","E83.42","E83.39","K59.01","R39.15","S82.132A","Z09.","K91.5","R14.0","K44.9","I49.1","I44.7","R94.31","I80.8"],"date":["2021-04-16","2021-09-29","2021-10-05","2021-03-30","2021-04-07","2021-04-15","2021-04-16","2021-11-25","2021-11-30","2021-04-16","2021-04-16","2021-11-30","2021-11-25","2021-11-25","2021-04-16","2021-12-16","2021-11-30","2021-04-16","2021-05-12","2021-11-30","2021-11-30","2021-09-29","2021-12-10","2021-12-16","2021-06-21","2021-11-25","2021-12-10","2021-12-16","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-04-16","2021-04-15","2021-04-16","2021-04-16","2021-04-16","2021-05-03","2021-09-30","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-25","2020-11-11","2020-12-03","2020-12-03","2020-11-10","2021-08-20","2021-03-30","2021-02-03","2021-03-30","2021-05-12","2021-05-12","2021-07-22","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-12-10","2021-12-16","2021-03-24","2021-03-24","2021-09-29","2021-09-29","2021-09-29","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-22","2021-03-26","2021-03-26","2021-03-26","2021-03-30","2021-09-23","2021-04-07","2021-05-26","2021-05-26","2021-05-26","2021-11-12","2021-11-12","2021-11-12","2021-12-16"],"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":[["","00173068220","VENTOLIN HFA                                                          ","","18","Select","Select",""],["","31722053805","LEVETIRACETAM                                                         ","750MG","180","Select","Select",""],["","31722070110","LOSARTAN POTASSIUM                                                    ","50MG","-180","Select","Select",""],["","24979003702","METOPROLOL SUCCINATE ER                                               ","25MG ER","30","Select","Select",""],["","00487030101","ALBUTEROL SULFATE                                                     ","0.63MG\/3","-270","Select","Select",""],["","00469260290","MYRBETRIQ                                                             ","50MG","90","Select","Select",""],["","57237002801","AMOXICILLIN                                                           ","500MG","21","Select","Select",""],["","69097031987","BUDESONIDE                                                            ","0.5MG\/2","120","Select","Select",""],["","64380090807","DONEPEZIL HYDROCHLORIDE                                               ","10MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE                                                            ","40MG","90","Select","Select",""],["","00185093998","CHOLESTYRAMINE LIGHT                                                  ","4GM LITE","-30","Select","Select",""],["","69618003206","SIMETHICONE                                                           ","125MG","180","Select","Select",""],["","50228014610","HYDROCHLOROTHIAZIDE                                                   ","12.5MG","90","Select","Select",""],["","62756024064","ONDANSETRON ODT                                                       ","4MG ODT","-90","Select","Select",""],["","00245003660","PREVALITE                                                             ","4GM PK","30","Select","Select",""],["","57896070310","IRON                                                                  ","325MG","90","Select","Select",""],["","54629064501","FERROUS GLUCONATE                                                     ","324MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","HFA","18","Select","Select",""],["","80777027310","MODERNA COVID-19 VACCINE                                              ","COVID-19","0","Select","Select",""],["","64980051415","TIMOLOL MALEATE                                                       ","0.5% OP","15","Select","Select",""],["","68382005101","MELOXICAM                                                             ","15MG","30","Select","Select",""],["","43547027609","DONEPEZIL HCL                                                         ","10MG","90","Select","Select",""],["","11845009151","OYSTER SHELL CALCIUM 500                                              ","500MG","180","Select","Select",""],["","42806001801","SULINDAC                                                              ","150MG","60","Select","Select",""],["","57664037713","TRAMADOL HCL                                                          ","50MG","30","Select","Select",""],["","55513071001","PROLIA                                                                ","60MG\/ML","1","Select","Select",""],["","00904679480","ASPIRIN LOW DOSE                                                      ","81MG","90","Select","Select",""],["","70000017801","ADULT ASPIRIN REGIMEN                                                 ","81MG EC","90","Select","Select",""],["","00280210012","                                                                      ","","90","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":""}]}]}