{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COURTNEY   R WIGGINS","gend":1,"add":"431 N CHALICE COURT","city":"NEWPORT NEWS                  ","state":"VA","zip":"23608-1682","dob":"1987-12-18","age":"","mstatus":"","insh":4446494,"cliId":"","pno":7573237990,"cno":"","email":"","ename":"","eno":"","pphy":"BUMANGLAG, LEILA","ppno":7572782240,"pcpadd":"155 Kingsley Ln Ste 400,","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235054629,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"431 N CHALICE COURT","add3":"","madd1":"431 N CHALICE COURT","madd2":"APT F","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23608-1682","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.644","M79.646","Z21","F17.210","Z79.899","B20","B18.1","R76.0","Z91.14","S16.1XXA","Z04.1","V43.92XA","Y93.89","Y92.410","Y99.8","S29.012A","V49.40XA","R76.8","F17.200","R10.9","Z71.7","K82.8","E66.01","R53.83","M54.9","M25.50","R60.0","Z65.9","Z87.891","F54","Z68.42","K76.0","Z86.19","Z23","A53.9","F34.81","Z72.0","M79.672","T14.90XA","S90.32XA","W10.9XXA"],"date":["2020-02-21","2020-02-21","2020-11-04","2021-06-03","2022-02-18","2022-02-18","2022-02-18","2020-05-21","2021-06-03","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2021-03-11","2022-02-18","2021-06-17","2022-02-18","2021-06-17","2021-11-16","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-11-16","2021-11-16","2022-01-18","2022-02-18","2022-02-18","2022-02-18","2019-02-08","2019-05-08","2019-06-30","2019-06-30","2019-06-30","2019-06-30"],"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":{"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":[["","53746010905","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","64679096201","AZITHROMYCIN","TAB 600MG","8","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","68462011940","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","61958210101","ODEFSEY","TAB ","30","Select","Select",""],["","00527293437","PREDNISONE","TAB 20MG","21","Select","Select",""],["","69238152301","TETRACYCLINE","CAP 500MG","56","Select","Select",""],["","50111033301","METRONIDAZOL","TAB 250MG","56","Select","Select",""],["","00363031901","SOOTHE","CHW 262MG","120","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","30","Select","Select",""],["","61958190101","GENVOYA","TAB ","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","40","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","20","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","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":""}]}]}