{"sno": "new", "year": "2025", "answer": [{"options": {"value": "CANDELARIA FAVELALORENZANA", "optionId": "un4v"}, "questionId": "UNK-lowx"}, {"options": {"value": 2000265043, "optionId": "unvvv"}, "questionId": "UNB-lowx"}, {"options": {"value": "1977-03-16", "optionId": "UNtdb"}, "questionId": "UNM-iz6p"}, {"options": {"value": "2025-08-08T16:37"}, "questionId": "UNW-iz6p"}, {"options": {"value": "8167665703", "optionId": "nuphno"}, "questionId": "NU-Phno"}, {"options": {"value": "p.tabbilos@focuscares.com", "optionId": "unb4v"}, "questionId": "UNQ-lowx"}, {"options": {"value": "Focus Care", "optionId": "unp4v"}, "questionId": "UNX-lowx"}, {"options": {"value": "Patricia Gail Tabbilos", "optionId": "unq4v"}, "questionId": "UNN-lowx"}, {"options": {"value": "Other", "optionId": ["nuepq"]}, "questionId": "NU-w165"}, {"options": {"value": "Patient is a 48 y/o Hispanic female with active h/o DM type 2, ESRD on hemodialysis (MWF), legally blind and deaf on L eye and L ear , respectfully. <br>Non -urgent case management referral was sent:<br>- To Discuss with PCP/clinician regarding:  Bilateral arm upper arm pain upon moving arm on back and has some difficulty putting bra on, to discuss PT eval with PCP and her concerns regarding her stress incontinence. She has no handicap parking and is asking if patient could have one since she has h/o falling x 3; legally blind, L eyes and legally deaf, L ear; She is also interested to discuss about advanced directives with provider; Cholesterol and HIV/STI screening - patient does not know if this was done within the past 3 years; Last dental exam: 2022; and to discuss eGFR and urine albumin-creatinine ratio since patient stated that she is not aware if this was done within the past year.<br><br>- Needs social support evaluation- Her home has issues with air conditioning and the bathroom has 2 holes (one hole by the floor, which is next to tub and is \"getting bigger\" and one home is next to toilet area); Resources for food and housing disparity;  No smoke and carbon monoxide detectors at home, and requesting for a cane, patient has history of falls x 3 within the past year.<br>", "optionId": "UNC-MV65"}, "questionId": "UNC-MV65"}, {"options": {"value": "7205909964", "optionId": "uni4v"}, "questionId": "UNS-lowx"}, {"options": {"value": "Yes", "optionId": "unsu8"}, "questionId": "UNQ-jtcz"}, {"options": {"value": "No", "optionId": "unl6B"}, "questionId": "UNA-que"}, {"options": {"value": "No", "optionId": "unl6D"}, "questionId": "UNB-que"}, {"options": {"value": "<br>- To Discuss with PCP/clinician regarding:  Bilateral arm upper arm pain upon moving arm on back and has some difficulty putting bra on, to discuss PT eval with PCP and her concerns regarding her stress incontinence. She has no handicap parking and is asking if patient could have one since she has h/o falling x 3; legally blind, L eyes and legally deaf, L ear; She is also interested to discuss about advanced directives with provider; Cholesterol and HIV/STI screening - patient does not know if this was done within the past 3 years; Last dental exam: 2022; and to discuss eGFR and urine albumin-creatinine ratio since patient stated that she is not aware if this was done within the past year.<br><br>- Needs social support evaluation- Her home has issues with air conditioning and the bathroom has 2 holes (floor area); Resources for food and housing disparity;  No smoke and carbon monoxide detectors at home, and requesting for a cane, patient has history of falls x 3 within the past year.", "optionId": "unl6l"}, "questionId": "UNP-gbms"}], "clientId": "client_015", "memberId": 2000265043, "referralId": "nuvu8", "submittedBy": "PTabbilos", "sentToQADate": "2025-08-08T22:40:42.345Z", "submittedUserType": "nurse", "referralFormStatus": "0", "sentToHelpLineDate": ""}