{"sno": "new", "year": "2025", "answer": [{"options": {"value": "RICARDO SEANEZ JAQUEZ", "optionId": "u4v"}, "questionId": "K-lowx"}, {"options": {"value": 2000211609, "optionId": "vvv"}, "questionId": "B-lowx"}, {"options": {"value": "1961-01-09", "optionId": "tdb"}, "questionId": "M-iz6p"}, {"options": {"value": "2025-08-15T14:00"}, "questionId": "W-iz6p"}, {"options": {"value": "7202981012", "optionId": "uphno"}, "questionId": "U-Phno"}, {"options": {"value": "p.tabbilos@focuscares.com", "optionId": "b4v"}, "questionId": "Q-lowx"}, {"options": {"value": "Focus Care", "optionId": "p4v"}, "questionId": "X-lowx"}, {"options": {"value": "Patricia Gail Tabbilos", "optionId": "q4v"}, "questionId": "N-lowx"}, {"options": {"value": "HTN", "optionId": ["uz0"]}, "questionId": "U-w165"}, {"options": {"value": "Patient is a 64 y/o Hispanic male with HTN, ESRD, currently on hemodialysis - MWF, s/p 2 cardiac stent placement d/t MI in 2017, h/o prostate CA (2015) ; radiation tx completed in 2021 and had follow up with oncologist last 07/2025, patient said that he is on remission. He is currently non-adherent with medications. He stated that he does not want to take all meds as prescribed to him since he has a lot of medications to take and is afraid to cause very bad side effects. He has scheduled an appointment with PCP on 08/21/25.<br>Urgent case management referral:<br>-Needs to notify and discuss with PCP regarding: high BP readings: 156/78; repeat BP readings: 160/80; needs to discuss medication adherence, side effects of medications - patient's wife stated that his BP readings are uncontrolled since he is not taking Labetalol as prescribed. He is asymptomatic during the visit. Also, had one episode of fall (6 months ago) and may need referral for PT/OT eval and/or fall prevention program, patient lives in basement and wife helps him with shower, he is using cane to go upstairs to go outside the house.<br><br>Non-urgent case management referral:<br>- Needs social support evaluation:  lives at the basement level house with wife and stated that they cannot afford the rent;  he is interested to do something that will make him busy using his hands such as packaging.", "optionId": "C-MV65"}, "questionId": "C-MV65"}, {"options": {"value": "720590996", "optionId": "i4v"}, "questionId": "S-lowx"}, {"options": {"value": "Yes", "optionId": "su8"}, "questionId": "Q-jtcz"}, {"options": {"value": "No", "optionId": "l6B"}, "questionId": "A-que"}, {"options": {"value": "No", "optionId": "l6D"}, "questionId": "B-que"}, {"options": {"value": "Urgent case management referral:<br>-Needs to notify and discuss with PCP regarding: high BP readings: 156/78; repeat BP readings: 160/80; needs to discuss medication adherence, side effects of medications - patient's wife stated that his BP readings are uncontrolled since he is not taking Labetalol as prescribed. He is asymptomatic during the visit. Also, had one episode of fall (6 months ago) and may need referral for PT/OT eval and/or fall prevention program, patient lives in basement and wife helps him with shower, he is using cane to go upstairs to go outside the house.<br><br>Non-urgent case management referral:<br>- Needs social support evaluation:  lives at the basement level house with wife and stated that they cannot afford the rent;  he is interested to do something that will make him busy using his hands such as packaging.", "optionId": "l6l"}, "questionId": "P-gbms"}], "clientId": "client_015", "memberId": 2000211609, "referralId": "vu8", "submittedBy": "PTabbilos", "sentToQADate": "2025-08-15T20:02:15.696Z", "submittedUserType": "nurse", "referralFormStatus": "0", "sentToHelpLineDate": ""}