{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA BINFORD","gend":1,"add":"VA BEACH HEALTHCARE","city":"VIRGINIA BEACH                ","state":"VA","zip":"23454-2401","dob":"1942-02-18","age":"","mstatus":"","insh":11001265,"cliId":"6E19A84TK20","pno":7579389130,"cno":7579389130,"email":"","ename":"","eno":"","pphy":"HAMBAZ, NASSER","ppno":7576717777,"pcpadd":"4876 Baxter Rd,","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234624404,"pcpcounty":"","pcpid":"P0060179","pcpname":"FIRST CHOICE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"1801 CAMELOT DRIVE","add3":"","madd1":"VA BEACH HEALTHCARE","madd2":"1801 CAMELOT DRIVE","madd3":"","mcity":"VIRGINIA BEACH","mstate":"VA","mzip":"23454-2401","pcpfaxno":7578537377,"pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["D50.8","K27.7","M62.81","R26.2","R33.9","F03.90","F33.9","J18.9","Z91.81","M16.12","M85.852","F22","F32.2","M81.0","E46","F29","S72.301K","E55.9","Z23","M20.40","M20.10","L85.3","B35.1","I70.209","M79.676","L82.1","D48.5","R53.81","D64.9","Z87.440","R41.0","R45.1","K21.9","R30.0","R82.90","F32.9","E53.8","M20.41","M20.42","M20.11","M20.12","R53.1","D50.9","H25.13","F02.81","L60.0","M79.675","K27.9","H66.92","M25.511","W19.XXXA","M25.611","K08.89","K03.81","H61.21","H92.01","R07.89","R21","K59.00","R52","G47.00","R63.4","D69.6","E70.8","D51.9","E72.20","U07.1","E78.5","E70.89","R63.5","N39.0","R35.1","S72.302K","Z16.12","R31.9","Z79.899","R05","J98.8","R06.2","N30.00","E11.9","I10","B37.2","D69.2","Z53.29","Z13.79","Z99.89","Z68.22","R11.0","R10.9","R10.819","R45.851","F41.1","F33.0","M21.6X2"],"date":["2021-09-01","2021-09-01","2021-01-01","2021-09-01","2021-09-01","2021-10-27","2021-09-01","2019-10-01","2021-09-01","2021-09-01","2021-09-01","2019-10-01","2019-10-01","2021-09-01","2020-04-13","2019-10-01","2019-10-01","2021-10-27","2021-09-01","2021-08-22","2021-08-22","2021-08-22","2021-04-12","2021-04-12","2021-04-12","2019-01-15","2019-01-17","2020-01-23","2021-10-27","2020-01-23","2021-10-19","2020-01-23","2021-10-27","2018-11-19","2018-02-06","2021-10-27","2019-04-02","2021-04-12","2021-04-12","2018-02-11","2018-02-11","2019-11-11","2018-12-11","2021-07-30","2018-12-18","2020-06-29","2020-06-29","2020-04-13","2020-04-13","2019-04-16","2019-04-16","2019-04-16","2018-04-20","2018-04-20","2018-05-15","2018-05-15","2020-06-11","2020-06-11","2020-08-07","2021-10-27","2021-10-27","2018-06-19","2021-10-27","2020-06-25","2020-06-22","2020-12-11","2020-09-01","2020-10-07","2020-12-16","2018-10-12","2021-07-15","2019-10-31","2017-11-01","2017-11-06","2021-07-15","2021-10-28","2018-11-19","2018-11-19","2018-11-19","2018-12-11","2020-12-15","2021-08-27","2019-12-18","2021-01-15","2021-02-18","2021-01-15","2020-03-30","2020-03-30","2021-07-14","2021-07-14","2021-07-14","2021-08-13","2021-10-19","2021-10-20","2021-08-22"],"priorHcc":[null,null,"",null,null,null,null,"",null,null,null,"","",null,"","","",null,null,null,null,null,null,null,null,"","","",null,"",null,"",null,"","",null,"",null,null,"","","","",null,"","","","","","","","","","","","","","","",null,null,"",null,"","","","","","","",null,"","","",null,null,"","","","","",null,"","","",null,null,null,null,null,null,null,null,null,null]}},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","00781286810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00527512570","LACTULOSE","10GM\/15","473","Select","Select",""],["","68180024906","MEMANTINE","28MG ER","14","Select","Select",""],["","55111015330","ONDANSETRON","4MG","10","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","25","Select","Select",""],["","45802005911","NYSTATIN","100000","30","Select","Select",""],["","00472037945","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","65862001105","SERTRALINE","25MG","1","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","6","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","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":""}]}]}