{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HARRIET MALBON","gend":1,"add":"1402 CAROLON DR","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1956-11-23","age":"","mstatus":"","insh":"2207388*01","cliId":"","pno":"757\/491-6225","cno":"757\/491-6225","email":"","ename":"","eno":"","pphy":"LISNER, CHARLES A MD","ppno":"757\/252-9300","pcpadd":"STE 900 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161498,"pcpname":"SMG - Dedicated Care Center","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9278","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D48.5","D22.9","L82.1","H04.123","H25.813","K52.89","Z12.11","I10.","R00.2","M79.89","E78.5","R94.6","M85.80","E55.9","E53.8","R73.03","I31.3","R94.5","I65.29","I70.90","K52.831","R71.0","R91.8","R10.13","Z12.31","I65.22","R35.0","R53.83","R80.9","L81.4","L20.9","M25.512","M79.602","L30.9","R20.2","Z12.39","I65.23","I49.1","I47.1","I49.3","Z00.00","Z12.4","Z23.","R19.7","R11.0","M54.5","M25.552","R05.","J06.9","R41.3","F43.9","G47.9","F32.9","D18.01","R90.89","H43.813"],"date":["2021-08-09","2021-08-09","2021-08-09","2021-09-20","2021-09-20","2021-07-20","2020-08-25","2021-08-03","2021-06-08","2020-11-18","2021-08-03","2021-07-07","2021-08-03","2021-08-03","2021-07-07","2021-08-03","2021-08-03","2020-11-18","2021-08-03","2021-08-03","2021-08-03","2020-11-18","2021-03-31","2021-03-31","2020-11-18","2021-08-19","2021-03-31","2021-08-03","2021-03-31","2020-02-18","2020-02-18","2020-07-02","2020-07-02","2020-01-15","2020-07-02","2020-11-18","2021-08-19","2021-01-13","2021-01-13","2021-01-13","2021-03-31","2021-03-31","2020-07-02","2021-07-22","2021-07-20","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-08-03","2021-07-07","2021-08-03","2021-08-03","2021-08-09","2021-08-03","2021-09-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","50742061710","METOPROL","100MG ER","45","Select","Select",""],["","68180095604","CLOBETASOL","0.05%","-60","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","30","Select","Select",""],["","10370010250","BUPROPN","300MG XL","30","Select","Select",""],["","00574220545","TRETINOIN","0.05%","45","Select","Select",""],["","00555087202","MEDROXYPR","2.5MG","30","Select","Select",""],["","62559014901","ESTROG\/MTEST","1.25-2.5","30","Select","Select",""],["","65162077810","BUDESONIDE","3MG DR","90","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","68180021709","LOSARTAN\/HCT","100-25","30","Select","Select",""],["","50111043401","TRAZODONE","100MG","60","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","30","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","12","Select","Select",""],["","00115132019","COLESEVELAM","625MG","120","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","30","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","51672404806","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","00254200801","COLCHICINE","0.6MG","30","Select","Select",""],["","68462038630","SOLIFENACIN","5MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","30","Select","Select",""],["","68180095604","CLOBETASOL ","0.05%","-60","Select","Select",""],["","68180021709","LOSARTAN\/HCT ","100-25","30","Select","Select",""],["","65162077810","BUDESONIDE ","3MG DR","90","Select","Select",""],["","50742061710","METOPROL ","100MG ER","45","Select","Select",""],["","10370010250","BUPROPN ","300MG XL","30","Select","Select",""],["","50111043401","TRAZODONE ","100MG","60","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","30","Select","Select",""],["","62559014901","ESTROG\/MTEST ","1.25-2.5","30","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","30","Select","Select",""],["","00555087202","MEDROXYPR ","2.5MG","30","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","30","Select","Select",""],["","00574220545","TRETINOIN ","0.05%","45","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","69097015807","MELOXICAM ","7.5MG","30","Select","Select",""],["","00115132019","COLESEVELAM ","625MG","120","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","30","Select","Select",""],["","13107008305","LORAZEPAM ","0.5MG","30","Select","Select",""],["","68462038630","SOLIFENACIN ","5MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","6","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","6","Select","Select",""],["","23155028801","ACETAZOLAMID","250MG","14","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","23155028801","ACETAZOLAMID ","TAB 250MG","14","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}