{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EILSELEPOP T","gend":0,"add":"      tS latnenitnoC 7153                         ","city":"Virginia Beach           ","state":"VA","zip":"23452-4313","dob":"1969-12-13","age":"","mstatus":"","insh":"00114278","cliId":"","pno":"6975758311","cno":"","email":"","ename":"","eno":"","pphy":"HAMBAZ, NASSER","ppno":7576717777,"pcpadd":"4876 BAXTER RD,  ","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234624404,"pcpcounty":"","pcpid":"","pcpname":"FIRST CHOICE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"7525 TIDEWATER DR                                 ","madd2":"                                                  ","madd3":"","mcity":"VIRGINIA BEACH           ","mstate":"VA","mzip":"23462-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","B86","F33.1","F70","F31.81","F84.5","F23","F31.32","R17","Z98.890","Z86.010","R19.7","R19.4","K63.5","F66","F31.9","J00","Z12.11","Z11.1","Z12.5","R10.9","K50.90","J45.909","F84.0","Z79.899","L20.9","K63.89","D12.2","F98.8","Z01.818","Z00.00","K59.00","G31.84","Z68.28","E70.0","R15.9","K59.1","R21"],"date":["2022-02-18","2020-01-15","2020-11-30","2022-07-22","2020-11-30","2022-07-22","2022-07-22","2022-04-07","2021-05-27","2022-06-14","2022-06-14","2022-04-07","2021-12-07","2021-12-07","2021-02-23","2022-06-06","2020-02-27","2022-06-06","2020-02-27","2020-05-28","2020-05-12","2020-05-12","2020-05-12","2022-06-06","2022-06-06","2020-02-12","2020-05-12","2022-06-06","2020-11-24","2020-05-08","2020-02-05","2020-01-16","2020-01-16","2020-01-16","2020-03-05","2022-04-18","2022-04-18","2020-02-05"],"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":[["","65862070360","ZIPRASIDONE","CAP 40MG","60","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","00603243821","BENZTROPINE","TAB 1MG","30","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","90","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","90","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","120","Select","Select",""],["","70370108001","INGREZZA","CAP 80MG","23","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","120","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","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":""}]}]}