{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANIRTAKNNIUQ A","gend":1,"add":"        DR ELTTILOOD  021                         ","city":"HAMPTON                  ","state":"VA","zip":"23669-9998","dob":"1994-05-23","age":"","mstatus":"","insh":"00111333","cliId":"","pno":"3575798615","cno":7574069913,"email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA SLEDD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE 1ST FLOOR SUITE 118,HOFHEIMER HALL","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"","pcpname":"GHENT FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"120  DOOLITTLE RD                                 ","madd2":"                                                  ","madd3":"","mcity":"HAMPTON                  ","mstate":"VA","mzip":"23669-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","E66.01","F17.210","F41.1","K21.9","R19.7","Z62.819","Z68.33","Z79.899","F31.9","F25.1","F10.10","F12.90","F15.10","F60.9","K21.0","R10.9","F25.9","R44.0","R44.1","R45.850","R45.851","F43.10","Z91.19","G47.00","J30.9","F17.200","F31.4","K58.9","Z20.2","Z71.6","Z23","Z11.3","F15.21","E66.9","R10.10","R31.9","R35.0","M79.10","Z13.6","R82.3","D58.2","R73.09","R39.198","N76.0","A59.8","K92.1","R11.2","E11.9","Z87.19","Z20.828","F22","F30.9","R44.3","E55.9","N39.0","E78.5","I10","Z76.89","S09.90XA","W01.0XXA","W01.190A","Z86.19","Z86.32","M54.2","S00.93XS","W19.XXXS","L65.9","R53.83","R30.0","J34.89","J06.9","L72.9","R04.0","G47.30","J20.9","R05","R07.9","F41.9","R07.2","R09.89","R07.89","J02.9","R51","N89.8","L02.92","B37.3","L90.5","Z30.431","L73.2","L70.0","B07.8","L53.8","R10.32","N94.10","Z91.83","Z91.14","F32.9","R45.1","G47.9","Z20.822","F33.2","T07.XXXA","R09.81","F66","A54.9","A74.9","Z01.411","Z12.39","Z12.4","R12","F31.2","Z00.00","Z30.9","L63.9","B82.9","R19.5","E03.9","F20.9","N18.9","S30.1XXA","V49.60XA","Y92.410","V89.2XXA","Y92.810","Y93.89","T14.90XA","R69","R87.610","D50.9","Z00.01","Z13.220","Z13.1","Z13.9","E07.9","Z72.0","Z71.3","F32.A","R39.15","L70.9","K64.4","K62.89"," "],"date":["2022-11-01","2018-08-30","2022-09-06","2018-08-30","2020-01-07","2022-09-06","2018-08-30","2018-08-30","2022-11-04","2021-08-30","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2018-09-06","2019-10-27","2022-08-11","2018-09-09","2018-09-09","2018-09-10","2021-04-27","2018-09-10","2018-09-10","2022-08-11","2022-04-04","2020-01-07","2018-09-14","2021-09-15","2022-09-06","2021-09-15","2021-09-15","2022-08-11","2022-04-04","2018-09-26","2019-10-02","2019-10-02","2020-03-08","2020-02-02","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-23","2019-10-23","2019-10-23","2019-10-27","2019-10-27","2019-10-27","2019-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2019-08-09","2022-08-24","2019-11-19","2021-04-27","2020-11-29","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2021-05-01","2020-12-05","2020-12-05","2021-12-07","2021-12-07","2021-12-07","2018-12-14","2020-02-02","2018-12-14","2018-12-14","2019-12-30","2019-12-30","2020-02-02","2020-01-03","2022-03-18","2020-01-04","2020-01-04","2020-01-07","2020-02-02","2020-02-02","2022-09-06","2022-08-24","2021-06-23","2019-02-20","2019-02-21","2019-05-02","2019-05-02","2019-03-04","2019-03-04","2020-03-08","2020-03-08","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-28","2021-05-01","2020-05-08","2019-05-10","2019-05-10","2019-05-10","2019-08-09","2019-05-10","2021-06-23","2018-05-11","2018-08-05","2021-06-23","2018-05-17","2018-05-17","2018-05-23","2018-05-23","2018-05-23","2018-05-27","2018-05-31","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2021-06-23","2018-07-20","2018-07-20","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2018-07-22","2018-08-02","2022-03-18","2022-08-24","2022-08-24","2022-09-06","2022-09-06","2022-11-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","10147095303","PALIPERIDONE","TAB ER 6MG","60","Select","Select",""],["","55111053401","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","90","Select","Select",""],["","68382011514","RISPERIDONE","TAB 2MG","60","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","14","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","50","Select","Select",""],["","69452015020","VALPROIC","CAP 250MG","120","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","28","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","50458056401","INVEGA","INJ 234\/1.5","1.5","Select","Select",""],["","00574220545","TRETINOIN","CRE 0.0005","45","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","00168016215","CLOBETASOL","OIN 0.0005","30","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","18","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","65757040303","ARISTADA","INJ 882MG\/3","3.2","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":""}]}]}