{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH F HEIDEN","gend":0,"add":"914 MATTOX AVE","city":"COLONIAL BEACH","state":"VA","zip":"22443-9998","dob":"1955-05-24","age":"","mstatus":"","insh":"900050172*01","cliId":"","pno":"8049255426","cno":"","email":"","ename":"","eno":"","pphy":"GORDON, CARLENE K","ppno":3014960000,"pcpadd":"125 Olde Greenwich Dr Ste 220","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":"22408-4010","pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5406449508,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.69","Z12.11","M62.830","M47.816","M47.817","M62.838","Z92.29","M79.674","Z01.818","G89.29","I65.23","I10.","I15.9","R06.00","E11.65","N18.32","E11.22","E11.29","N18.30","N40.0","R80.9","E78.5","R35.1","E53.8","R51.9","E11.8","I12.9","R80.0","N28.1","E87.5","L97.512","E11.40","M20.41","M19.071","L60.3","B35.1","M25.571","R00.0","E78.00","M54.12","M54.2","G62.9","R06.09","K75.81","K76.0","I34.0","R79.89","R06.02","M50.30","E11.9","M54.6","T14.90XA","M86.9","C92.11","N52.9","E11.51","I73.9","M50.20","M79.7","I70.0"],"date":["2023-03-01","2022-07-14","2023-01-12","2023-10-16","2023-08-22","2023-01-12","2022-04-15","2022-06-01","2022-06-17","2022-06-01","2023-03-29","2023-03-29","2022-07-08","2022-09-30","2023-07-11","2023-04-19","2023-06-01","2022-02-02","2023-03-29","2022-08-03","2022-08-03","2022-02-02","2022-02-02","2023-03-29","2022-02-02","2023-11-01","2023-03-21","2023-04-19","2023-03-21","2023-10-25","2022-02-01","2023-03-30","2023-03-10","2023-09-07","2022-01-20","2023-03-10","2023-03-10","2023-03-29","2023-03-29","2022-05-31","2022-05-31","2022-12-22","2022-10-05","2022-10-05","2022-02-09","2022-09-30","2022-01-21","2022-09-30","2022-03-16","2023-09-14","2023-01-12","2023-01-12","2023-07-27","2023-03-29","2023-03-29","2023-03-30","2023-11-10","2023-10-23","2023-10-26","2023-11-10"],"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":[]},{"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":[["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","60","Select","Select",""],["","00378395005","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","72512092801","QUTENZA","8 %","4","Select","Select",""],["","72205001390","PREGABALIN","75 MG","180","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","Select","Select",""],["","49281012365","FLUZONE HIGH-DOSE QUAD","2023-24 240MCG\/0.7","0.7","Select","Select",""],["","55111046701","METOPROLOL SUCCINATE","50 MG","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","36","Select","Select",""],["","27241011403","TADALAFIL","20 MG","10","Select","Select",""],["","55111046701","METOPROL SUC TAB","50MG ER","90","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","90","Select","Select",""],["","65862020199","LOSARTAN POT TAB","25MG","90","Select","Select",""],["","59651029701","NIFEDIPINE TAB","90MG ER","90","Select","Select",""],["","65862014736","SUMATRIPTAN TAB","50MG","27","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","72205001290","PREGABALIN CAP","50MG","90","Select","Select",""],["","70710128601","BACLOFEN","20 MG","90","Select","Select",""],["","08627005303","DEXCOM G","6 SENSOR","9","Select","Select",""],["","00597015330","JARDIANCE","25 MG","60","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","400","Select","Select",""],["","00378395205","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","99073070827","FREESTYLE TES LITE","","100","Select","Select",""],["","08508300021","OMNIPOD","5 G6 PODS (GEN 5)","10","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","30","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","2","Select","Select",""],["","72512092801","QUTENZA KIT","8% 1-PCH","4","Select","Select",""],["","00005200010","PREVNAR","20 0.5 ML","0.5","Select","Select",""],["","43547036011","LOSARTAN POTASSIUM","25 MG","90","Select","Select",""],["","50742062201","NIFEDIPINE ER","90 MG","90","Select","Select",""],["","80777027310","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","70461012103","FLUAD QUADRI INJ","2021-22","0","Select","Select",""],["","16729037210","TADALAFIL TAB","20MG","20","Select","Select",""],["","17478030703","AZASITE SOL","1%","2","Select","Select",""],["","00069034401","ABRYSVO","120MCG\/0.5","1","Select","Select",""],["","68645057454","GLIPIZIDE TAB","5MG","180","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX5\/32","100","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}