{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ANNAHSEDSNIBBOR R ","gend":1,"add":"OSNAWS 56YAWKRAP N","city":"PORTSMOUTH","state":"VA","zip":"23704-3926","dob":"1990-04-10","age":"","mstatus":"","insh":"01013772","cliId":"","pno":"8375789021","cno":7573812098,"email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA SLEDD","ppno":7574465955,"pcpadd":"825 Fairfax Ave, Ste 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"65 SWANSON PARKWAY","madd2":"                                                            ","madd3":"","mcity":"PORTSMOUTH","mstate":"VA","mzip":"23704-3926","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z33.1","Z36.2","Z3A.25","O09.93","O09.293","Z98.891","Z3A.29","O14.13","A41.9","N83.292","N73.0","R10.9","N93.9","O10.013","Z3A.32","Z3A.33","R91.8","N73.9","A54.9","N83.202","K57.30","I10","F12.90","D64.9","K59.00","Z90.49","M54.5","Z36.89","Z87.59","Z3A.31","Z39.1","Z34.82","Z34.83","O28.8","Z3A.35","R10.32","Z87.891","Z79.899","Z23","O14.14","O36.8130","O34.212","Z37.0","O99.344","F32.9","F41.9","N73.6","O99.89","G89.18","Z86.2","Z30.2","Z28.21","Z3A.34","R52","R18.8","R10.84","R00.0","M54.9","R53.1","R32","O09.292","O10.012","O35.9XX0","O36.5930","Z3A.28","N30.01","N76.0","B96.89","B37.3","O16.2","Z3A.27","O32.8XX0","N83.209","T14.90XA","R10.814","N89.8"],"date":["2019-01-18","2019-01-18","2019-01-18","2019-03-29","2019-03-29","2019-02-28","2019-02-14","2019-03-30","2019-08-14","2019-08-14","2019-08-19","2019-08-19","2019-08-19","2019-03-22","2019-03-12","2019-03-19","2019-08-14","2019-08-14","2019-08-14","2019-08-15","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2021-02-15","2019-03-01","2019-03-01","2019-03-01","2019-03-27","2019-03-27","2019-03-27","2019-03-29","2019-03-30","2019-08-14","2020-11-24","2019-08-13","2019-03-29","2019-03-30","2019-03-30","2019-03-30","2019-03-30","2019-03-29","2019-03-29","2019-03-29","2019-03-29","2019-03-29","2019-03-31","2019-03-29","2019-03-30","2019-03-29","2019-03-22","2019-08-13","2019-08-14","2019-08-14","2019-08-14","2021-02-16","2021-02-16","2021-02-16","2019-01-31","2019-01-18","2019-02-07","2019-02-07","2019-02-07","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2019-01-31","2019-01-31","2019-03-30","2019-08-14","2021-02-16","2019-08-13","2020-11-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","63044015001","PRENATAL ","TAB LOW IRON","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","00904585652","CALCIUM ","TAB 600MG","60","Select","Select",""],["","16714069211","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00548560300","ENOXAPARIN ","INJ 60\/0.6ML","4.2","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00904645780","DOK ","CAP 100MG","30","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","66685100101","AMOX\/K ","TAB 875-125","18","Select","Select",""],["","42858010250","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","32","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","15","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}