{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"K AERDNARETRAC ","gend":1,"add":"            TS LRAEP 6112                         ","city":"PORTSMOUTH               ","state":"VA","zip":"23704-9998","dob":"1979-01-10","age":"","mstatus":"","insh":"00119752","cliId":"","pno":"3775796975","cno":"","email":"","ename":"","eno":"","pphy":"ANGLIN, VICTOR T","ppno":7577381225,"pcpadd":"3537 AIRLINE BLVD STE 1,","pcpcity":"Portsmouth","pcpstate":"VA","pcpzip":237012650,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL GROUP HAMPTON ROADS PRIMARY CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"5645 Darby Close                                  ","madd2":"                                                  ","madd3":"","mcity":"Portsmouth               ","mstate":"VA","mzip":"23703-1615","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","G47.30","Z83.71","Z12.31","E66.01","Z11.59","J18.9","R05","R52","R50.9","R50.81","K21.9","Z68.41","Z79.3","Z88.4","Z91.040","R07.89","R07.9","U07.1","Z79.899","R07.2","N76.0","R09.89","B96.89","J06.9","E78.00","Z87.891","Z20.828","T50.B95A","R06.02","I10","Z23","N92.6","M19.272","E66.9","J02.9","H66.93","R00.0","M79.601","Z82.49","N93.9","R68.83","M79.10","R53.1","T50.Z95A","R05.9","Z99.89","M19.072","Z68.42","B37.2","N94.6","N92.1","N62","M54.9","G89.29","M54.40","S39.012A","K52.9","M54.5","X50.0XXA","X50.3XXA","Y93.H3","Y92.89","Y99.0","Z88.6","Z98.890","J01.00","Z12.4","R10.9","R09.81","Z68.39","Z13.220","R11.2"," "],"date":["2021-02-25","2021-10-17","2021-02-25","2021-03-30","2022-08-09","2022-08-22","2019-03-12","2020-08-04","2019-03-12","2019-03-12","2019-03-12","2022-07-19","2022-08-09","2019-03-12","2019-09-17","2019-09-17","2021-09-23","2021-09-23","2022-07-19","2022-07-19","2021-09-23","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2022-07-19","2022-07-19","2020-12-10","2021-09-23","2021-09-23","2022-08-22","2019-10-08","2021-05-03","2021-05-03","2021-05-03","2019-04-30","2019-04-30","2019-04-30","2020-07-22","2020-07-22","2021-08-03","2020-08-04","2020-08-04","2021-09-23","2021-09-23","2022-07-19","2020-02-24","2020-02-24","2020-02-24","2021-08-06","2022-08-09","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2019-09-17","2019-09-17","2018-08-27","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2018-09-28","2022-08-09","2022-07-19","2022-07-19","2022-07-19","2022-08-22","2022-07-19","2022-08-22"],"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":[["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00254203080","TRI-PREVIFEM","TAB ","84","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","68308015215","NYSTATIN","POW 100000","15","Select","Select",""],["","70700012185","TRI-ESTARYLL","TAB ","84","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","30.00","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","8","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","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":""}]}]}