{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F YLIMEHCSRIK ","gend":1,"add":"AHWOP 6126EUNEVA NAT","city":"Norfolk","state":"VA","zip":"23508-9998","dob":"1980-02-20","age":"","mstatus":"","insh":"10115652","cliId":"","pno":"3575718371","cno":7572744969,"email":"","ename":"","eno":"","pphy":"HOWELL, CHRISTINE LOUISE","ppno":7579552828,"pcpadd":"885 KEMPSVILLE RD STE 320,","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":"23502-3800","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":"6216 POWHATAN AVENUE","madd2":"","madd3":"","mcity":"Norfolk","mstate":"VA","mzip":"23508-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F29","F33.1","U07.1","M25.512","R06.02","M54.9","F17.210","Z91.041","F45.0","F33.3","F45.1","F22","F41.1","O99.350","R10.9","O26.899","O99.330","Z79.899","F15.20","F13.20","O09.522","O35.9XX0","Z3A.16","R07.9","Z74.3","O34.219","Z3A.23","O12.00","O99.891","R60.0","Z3A.00","Z53.29","O99.343","O42.92","Z03.71","F41.9","F32.9","F60.3","O09.523","O26.893","K02.9","O99.333","O09.293","Z3A.37","Z87.440","Z67.21","R05.9","Z20.822","I48.91","O09.90","O34.211","O99.324","O99.344","O99.334","F15.90","Z3A.38","Z37.0","Z30.2","O09.521","Z3A.10","R05","K08.89","R68.84","R22.0","Z88.8","Z51.89","O99.340","F15.10","Z3A.27","O36.80X0","Z3A.14","P28.89","O26.891","O99.331","Z53.21","Z3A.12","O26.90","R07.89","O99.323","F19.94","Z3A.28","O23.43","O09.33","O23.11","O23.591","Z3A.01","B96.89","B34.9","Z20.828","Z3A.34","O09.93","F98.8","O36.5930","O09.513","O09.893","Z3A.29","F99","H92.02","Z00.00","F32.A","R07.81","R10.30","R79.89","D72.829","R07.1","Z76.89","N30.00","N76.0","O99.341","O99.320","Z67.91","Z3A.36","O36.0930","I49.9","O99.332","Z3A.25","Z12.31","Z72.0","O35.2XX0","Z3A.19","O99.89","J34.89","R53.1","R53.83","R69","F11.20","F15.129","F17.200"],"date":["2020-03-09","2022-05-20","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-06-26","2022-05-06","2020-03-03","2021-01-08","2021-01-08","2023-06-28","2023-04-20","2020-08-12","2020-12-27","2020-08-12","2020-08-12","2020-08-26","2023-06-29","2023-01-26","2020-12-10","2020-11-16","2020-09-29","2020-12-28","2020-12-28","2020-12-01","2020-11-16","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-02-18","2021-02-18","2021-02-18","2021-02-28","2021-05-06","2022-05-20","2021-02-28","2021-02-18","2022-06-01","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-28","2021-11-09","2021-11-09","2021-05-06","2021-02-16","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2020-09-15","2020-08-22","2020-12-28","2022-06-26","2022-06-01","2022-06-01","2022-06-26","2021-03-17","2020-08-12","2020-08-12","2020-12-10","2020-09-15","2020-09-15","2021-02-28","2020-11-04","2020-11-04","2020-08-19","2020-08-25","2020-08-11","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2020-12-28","2020-12-28","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-06-10","2020-08-16","2021-01-29","2021-01-29","2020-05-05","2020-12-23","2020-12-23","2021-01-29","2020-12-23","2020-03-15","2020-06-10","2022-03-18","2022-03-18","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2021-10-06","2020-11-04","2020-11-04","2020-09-15","2021-02-16","2021-02-16","2021-02-16","2021-02-28","2020-05-04","2020-12-01","2020-12-01","2022-03-17","2022-03-17","2020-09-15","2020-10-19","2020-08-16","2021-11-09","2021-11-09","2021-11-09","2020-05-05","2023-07-31","2023-05-22","2023-06-29"],"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":[["","59148004580","ABILIFY MAIN","INJ 300MG","1","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","14","Select","Select",""],["","39328010610","PRENATAL","TAB 27-1MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","14","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65757040103","ARISTADA","INJ 441MG\/1.","1.6","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","59148004580","ABILIFY","INJ 300MG","1","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","12","Select","Select",""],["","59148004580","ABILIFY MAIN INJ","300MG","1","Select","Select",""],["","63304069205","CLINDAMYCIN CAP","150MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","39328010610","PRENATAL TAB","27-1MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","20","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","12","Select","Select",""],["","65862001705","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","69097015915","MELOXICAM TAB","15MG","14","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","20","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","12","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":""}]}]}