{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDY F KOERNER","gend":1,"add":"51 WELLESLEY DR APT 301 ","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1941-11-26","age":"","mstatus":"","insh":11001358,"cliId":"7N14YY1VG04","pno":7573164788,"cno":7573164788,"email":"","ename":"","eno":"","pphy":"MCGAVERN, MEGAN B ","ppno":7572344285,"pcpadd":"12652 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":236024392,"pcpcounty":"","pcpid":"P9059014","pcpname":"RIVERSIDE INTERNAL MEDICINE OF DENBIGH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"51 WELLESLEY DR APT 301 ","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23602-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.9","E53.8","E55.9","E11.65","Z79.84","F41.1","E11.36","E78.5","I10","L85.3","K04.7","M79.672","K13.70","Z79.899","Z12.11","Z12.12","E03.9","H25.13","H04.123","Z00.00","H25.11","H25.12","E78.00","Z79.82","Z83.518","Z88.0","Z88.2","Z96.1","H35.372","T38.3X6A","Z91.14","M54.12","M25.512","G89.29"],"date":["2021-11-04","2021-11-04","2021-11-04","2020-06-18","2021-11-04","2021-09-14","2021-09-14","2021-11-04","2021-11-04","2020-06-18","2018-05-11","2019-06-05","2020-06-18","2021-09-14","2019-07-08","2019-07-08","2021-11-04","2021-03-08","2021-03-08","2020-12-29","2021-09-14","2021-08-24","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-10-06","2021-10-13","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04"],"priorHcc":[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":[["","50458014030","INVOKANA","TAB 100MG","","Select","Select",""],["","378180510","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","66869040490","LIVALO","TAB 4MG","","Select","Select",""],["","65862006399","METOPROL TAR","TAB 50MG","","Select","Select",""],["","6057761","JANUMET","TAB 50-1000","","Select","Select",""],["","591024110","LORAZEPAM","TAB 1MG","","Select","Select",""],["","65862020199","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","60505014101","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","60432013350","CLOBETASOL","SOL 0.0005","","Select","Select",""],["","193731221","CONTOUR","TES NEXT","","Select","Select",""],["","378180510","LEVOTHYROXIN ","TAB 75MCG","90","Select","Select",""],["","65862006399","METOPROL ","TAB 50MG","180","Select","Select",""],["","6057761","JANUMET ","TAB 50-1000","180","Select","Select",""],["","50458014030","INVOKANA ","TAB 100MG","180","Select","Select",""],["","66869040490","LIVALO ","TAB 4MG","90","Select","Select",""],["","69315090510","LORAZEPAM ","TAB 1MG","90","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","90","Select","Select",""],["","31722070010","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","60432013350","CLOBETASOL ","SOL 0.0005","50","Select","Select",""],["","193731221","CONTOUR ","NEXT","200","Select","Select",""],["","65862006399","METOPROL","50MG","180","Select","Select",""],["","31722070010","LOSARTAN","25MG","90","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","24208043405","OFLOXACIN","0.3% OP","5","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","24208043405","OFLOXACIN ","DRO 0.3% OP","5","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":""}]}]}