{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EILLIWNWORB ","gend":0,"add":"ENIREHTACNAMEROF ","city":"Chesapeake","state":"VA","zip":"23324-3430","dob":"1945-07-13","age":"","mstatus":"","insh":"10113058","cliId":"","pno":"4575730443","cno":7578198557,"email":"","ename":"","eno":"","pphy":"GRAHAM, TAMARA NICOLE","ppno":7574102287,"pcpadd":"112 GAINSBOROUGH SQ STE 100,STE 100","pcpcity":"Chesapeake","pcpstate":"VA","pcpzip":"23320-1706","pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE REGIONAL MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"1013NELSON STREET","add3":"","madd1":"CATHERINE FOREMAN","madd2":"1013NELSON STREET","madd3":"","mcity":"Chesapeake","mstate":"VA","mzip":"23324-3430","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.1","R06.00","I25.5","I49.3","I10","I11.0","I50.9","Z87.39","Z68.21","Z79.899","Z74.09","Z74.1","Z99.89","Z71.89","Z96.1","Z98.41","Z98.42","H40.1132","I12.9","N18.2","M10.9","Z12.5","Z68.20","Z13.220","Z13.29","Z13.9","R63.4","H40.1114","I51.9","I42.8","R63.6","F17.210","Z68.1","H40.9","C91.Z0","D72.828","R79.89","E80.6","H40.021","I49.1","C18.8","Z87.891","Z82.49","E78.5","Z68.24","Z74.2","D50.9","E55.9","Z00.00"],"date":["2023-03-31","2022-09-09","2021-12-22","2022-09-09","2023-03-01","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2022-09-01","2022-09-01","2022-09-01","2023-03-31","2022-01-14","2021-09-24","2021-09-24","2021-09-24","2022-01-14","2022-12-08","2022-09-09","2022-09-09","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-08-11","2022-08-11","2022-01-14","2022-01-14","2021-09-07","2022-03-04","2022-08-11","2022-03-04","2022-03-04","2023-03-31","2021-12-22","2021-12-22","2023-03-31","2023-03-31","2023-03-31"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","68462016305","CARVEDILOL","TAB 6.25MG","180","Select","Select",""],["","59762033302","LATANOPROST","SOL 0.00005","5","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0.25","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","180","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0.25","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}