{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W P  YBBOBGRUBNERHA","gend":0,"add":"SAW E 6352TS NOTGNIH","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1979-03-23","age":"","mstatus":"","insh":"74000910*756","cliId":"","pno":"3975751415","cno":7577243727,"email":"","ename":"","eno":"","pphy":"FLETCHER, HAYLEY NP","ppno":7573542885,"pcpadd":"6160 KEMPSVILLE CIRCLE SUITE 325A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"MID-ATLANTIC POST ACUTE AND LONG TERM CARE PLLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","Z79.899","R68.89","F25.9","Z51.81","E78.5","K59.00","E03.9","E55.9","R79.1","R07.9","R05.","J98.4","R91.8","Z09.","Z87.01","Z87.09","R91.1","E66.9","J18.9","R07.81","Z20.822","Z88.8","Z88.0","Z87.891","R93.89","F20.9","F17.210","J18.1","U07.1"],"date":["2023-04-13","2023-01-06","2021-08-22","2022-05-02","2022-05-02","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2022-04-11","2022-01-10","2021-09-01","2022-01-10","2022-04-11","2023-03-29","2021-09-28","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-09-28","2022-02-10","2021-08-22","2021-09-28","2022-12-27"],"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":[["","69238183107","LEVOTHYROXIN","TAB 50MCG","31","Select","Select",""],["","65862084501","CLOZAPINE","50 MG","28","Select","Select",""],["","60505257809","ATORVASTATIN","TAB 10MG","31","Select","Select",""],["","62756079813","DIVALPROEX","TAB 500MG DR","62","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","5","Select","Select",""],["","69315013610","BENZTROPINE","TAB 0.5MG","30","Select","Select",""],["","00143314250","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00904656460","BENZONATATE","CAP 100MG","3","Select","Select",""],["","57896040110","DOCUSATE SOD","CAP 100MG","31","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","40985027416","D3 SUPER STR","CAP 2000UNIT","31","Select","Select",""],["","75834002001","VITAMIN D","3 CAP 50000UNT","5","Select","Select",""],["","49483034001","ACETAMIN","TAB 325MG","60","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","65862084605","CLOZAPINE 100","MG ","84","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM","50 MCG","30","Select","Select",""],["","60505257809","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","62756079813","DIVALPROEX SODIUM","500 MG","62","Select","Select",""],["","00378180310","LEVOTHYROXIN TAB","50MCG","31","Select","Select",""],["","00093440401","CLOZAPINE TAB","50MG","28","Select","Select",""],["","60505257809","ATORVASTATIN TAB","10MG","31","Select","Select",""],["","29300014005","DIVALPROEX TAB","500MG DR","62","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","69315013610","BENZTROPINE TAB","0.5MG","-30","Select","Select",""],["","70461032103","FLUCLVX QUAD INJ","2021-22","0","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","57896040110","DOCUSATE SOD CAP","100MG","31","Select","Select",""],["","00143314250","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","00904656460","BENZONATATE CAP","100MG","27","Select","Select",""],["","40985027416","D","3 SUPER STR CAP 2000UNIT","28","Select","Select",""],["","00904615760","VITAMIN D TAB","2000UNIT","28","Select","Select",""],["","49483034001","ACETAMIN TAB","325MG","60","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","20555000300","OYSTER SHELL CALCIUM","500(1250)","14","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","64980030550","DENTA","5000 PLUS 1.1 %","51","Select","Select",""],["","49483034001","ACETAMINOPHEN","325 MG","60","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":""}]}]}