{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VANESSA W SHARP","gend":1,"add":"4528 GREENWOOD DR ","city":"PORTSMOUTH  ","state":"VA","zip":"23701-9998","dob":"1969-07-13","age":"","mstatus":"","insh":11002411,"cliId":"1T36U76CE55","pno":7572921991,"cno":7572921991,"email":"","ename":"","eno":"","pphy":"RAMSEY, KRISTIN D ","ppno":7574883333,"pcpadd":"6111 Portsmouth Blvd","pcpcity":"Portsmouth  ","pcpstate":"VA","pcpzip":237011342,"pcpcounty":"","pcpid":"P0124257","pcpname":"FAMILY MEDICINE HEALTH CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4528 GREENWOOD DR ","madd2":"","madd3":"","mcity":"PORTSMOUTH  ","mstate":"VA","mzip":"23701-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E78.5","R31.9","R80.9","I10","J45.40","Z72.0","E66.01","G40.309","M70.61","R25.1","Z79.899","Z68.41","Z68.37","J30.9","G43.109","G47.61","Z68.38","F06.4","J30.89","G56.02","Z00.00","Z68.39","R05","Z13.31","R56.9","Z12.11","Z80.0","K03.1","E66.9","F17.210","G43.909","G89.29","H54.7","I49.9","J45.909","K59.00","M79.2","Z79.51","Z80.9","Z82.3","Z82.49","Z83.3","Z91.040","Z91.81","G40.909","Z12.31","Z28.21","E55.9","Z13.220","Z01.419","N76.0","Z12.72","R94.01","M21.6X1","L85.3","M20.11","M79.671","L60.0","Z11.3","A59.9","R76.8","D58.2","G45.9","G47.30","E66.3","J45.20"],"date":["2021-02-22","2020-03-03","2021-03-10","2021-01-29","2019-07-24","2020-10-08","2019-02-04","2020-10-08","2019-04-02","2019-07-24","2019-04-01","2019-02-04","2020-03-25","2021-01-29","2020-03-25","2020-03-25","2020-10-08","2018-03-27","2018-03-27","2018-03-27","2019-04-02","2019-07-24","2019-04-02","2021-03-10","2020-05-04","2019-12-04","2019-07-24","2019-07-24","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-11-25","2019-12-03","2019-10-30","2021-02-22","2019-11-25","2019-12-18","2019-12-18","2019-12-18","2019-12-19","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2021-02-22","2021-03-10","2021-03-10","2021-03-10","2020-10-08","2020-10-08","2020-10-08","2020-10-08"],"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":{"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":[["","173069700","ADVAIR DISKU","AER 500\/50","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","93770198","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","50742061710","METOPROL SUC","TAB 100MG ER","","Select","Select",""],["","59651010569","ELETRIPTAN","TAB 40MG","","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","43547027110","ROPINIROLE","TAB 2MG","","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","","Select","Select",""],["","16714087502","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","65862024708","LEVETIRACETA","TAB 750MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E HFA INH","","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","","Select","Select",""],["","67253090150","ALPRAZOLAM","TAB 0.5MG","","Select","Select",""],["","93310905","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","60505257909","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","45","Select","Select",""],["","93770198","LEVOCETIRIZI ","TAB 5MG","90","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","180","Select","Select",""],["","50742061710","METOPROL ","TAB 100MG ER","90","Select","Select",""],["","59651010569","ELETRIPTAN ","TAB 40MG","9","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","173069700","ADVAIR ","AER 500\/50","60","Select","Select",""],["","43547027110","ROPINIROLE ","TAB 2MG","90","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","270","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","93317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","67253090150","ALPRAZOLAM ","TAB 0.5MG","2","Select","Select",""],["","65862024708","LEVETIRACETA ","TAB 750MG","360","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","8","Select","Select",""],["","93310905","AMOXICILLIN ","500MG","28","Select","Select",""],["","50742061710","METOPROL","100MG ER","90","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","00093317431","ALBUTEROL","E HFA INH","8.5","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}