{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATRINA QUINN","gend":1,"add":"2832 E Princess Anne Rd ","city":"Norfolk  ","state":"VA","zip":"23504-3111","dob":"1994-05-23","age":"","mstatus":"","insh":11003331,"cliId":"4HA3GH1YT12","pno":7575351689,"cno":7579448185,"email":"","ename":"","eno":"","pphy":"DWYER, MEENAL","ppno":7575944111,"pcpadd":",","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236011602,"pcpcounty":"","pcpid":"P9058417","pcpname":"BRUTON AVENUE FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2832 E Princess Anne Rd ","madd2":"","madd3":"","mcity":"Norfolk  ","mstate":"VA","mzip":"23504-3111","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F25.0","F25.1","F10.10","F12.90","F15.10","F60.9","N76.0","Z11.3","R39.198","A59.8","K92.1","R10.9","R11.2","E11.9","F17.210","Z87.19","E55.9","N39.0","F25.9","Z79.899","E78.5","I10","G47.00","F31.9","Z76.89","S09.90XA","W01.0XXA","W01.190A","Z86.19","Z86.32","S00.93XS","W19.XXXS","J34.89","J06.9","L72.9","R04.0","G47.30","J20.9","R05","R07.9","F41.9","R07.2","R09.89","R07.89","K21.9","F17.200","F15.21","J02.9","M79.10","R51","N89.8","L02.92","B37.3","L90.5","Z30.431","L73.2","L70.0","B07.8","L53.8","R10.32","N94.10","R35.0","R09.81","F66","A54.9","A74.9","Z01.411","Z12.39","Z12.4","M54.2","R12","F31.2","Z00.00","Z30.9","L63.9","B82.9","R19.5","R82.3","E03.9","F20.9","N18.9","S30.1XXA","V49.60XA","Y92.410","V89.2XXA","Y92.810","Y93.89","T14.90XA","R69","D50.9","R19.7","Z00.01","R73.09","Z13.220","Z13.6","Z13.1","Z13.9","E07.9","Z72.0","Z68.33","Z71.3","D58.2","E66.01","F41.1","Z62.819","K21.0","R44.0","R44.1","R45.850","R45.851","F43.10","Z91.19","J30.9","F31.4","E66.9","R10.10","R31.9","Z20.828","F22","F30.9","R44.3","Z91.83","Z91.14","F32.9","R45.1","G47.9","Z20.822","F33.2","T07.XXXA","R87.610","K58.9","Z20.2","Z71.6","Z23"],"date":["2021-09-30","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2019-10-23","2021-09-15","2019-10-23","2019-10-23","2019-10-27","2019-10-27","2019-10-27","2019-10-27","2021-04-27","2019-10-27","2019-08-09","2020-12-30","2021-04-27","2020-11-29","2019-11-19","2021-04-27","2020-11-29","2021-08-30","2020-11-29","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-05","2020-12-05","2018-12-14","2020-02-02","2018-12-14","2018-12-14","2019-12-30","2019-12-30","2020-02-02","2020-01-03","2021-04-27","2020-01-04","2020-01-04","2020-01-07","2020-01-07","2020-01-07","2021-08-04","2020-02-02","2020-02-02","2020-02-02","2019-08-09","2019-02-20","2021-06-23","2019-02-20","2019-02-21","2019-05-02","2019-05-02","2019-03-04","2019-03-04","2020-03-08","2020-03-08","2020-03-08","2020-05-08","2019-05-10","2019-05-10","2019-05-10","2019-08-09","2019-05-10","2021-06-23","2021-05-01","2018-05-11","2018-08-05","2021-06-23","2018-05-17","2018-05-17","2018-05-23","2018-05-23","2019-10-02","2018-05-23","2018-05-27","2018-05-31","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2019-06-11","2018-07-20","2018-09-06","2018-07-20","2019-10-02","2019-08-09","2019-10-02","2019-08-09","2019-08-09","2019-08-09","2018-07-22","2018-08-30","2018-08-02","2019-10-02","2018-08-30","2018-08-30","2018-08-30","2018-09-06","2018-09-09","2018-09-09","2018-09-10","2021-04-27","2018-09-10","2018-09-10","2020-11-30","2018-09-14","2018-09-26","2019-10-02","2019-10-02","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-28","2021-05-01","2021-06-23","2021-09-15","2021-09-15","2021-09-15","2021-09-15"],"priorHcc":[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":[["","59651000305","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","","Select","Select",""],["","31722054501","LITHIUM CARB","CAP 300MG","","Select","Select",""],["","10370010250","BUPROPN HCL","TAB 300MG XL","","Select","Select",""],["","16729028912","BUSPIRONE","TAB 30MG","","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","55111053401","DIVALPROEX","TAB 500MG ER","","Select","Select",""],["","43547028950","BUPROPION","TAB 150MG SR","","Select","Select",""],["","69452015020","VALPROIC ACD","CAP 250MG","","Select","Select",""],["","574220545","TRETINOIN","CRE 0.0005","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","10147095303","PALIPERIDONE","TAB ER 6MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","527128201","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","406048410","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","69047103","CHANTIX","PAK 0.5& 1MG","","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","65757040303","ARISTADA","INJ 882MG\/3","","Select","Select",""],["","168016215","CLOBETASOL","OIN 0.0005","","Select","Select",""],["","50458056401","INVEGA ","INJ 234\/1.5","1.5","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","90","Select","Select",""],["","43547034206","RISPERIDONE ","TAB 2MG","60","Select","Select",""],["","16729028912","BUSPIRONE ","TAB 30MG","60","Select","Select",""],["","10370010250","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","574220545","TRETINOIN ","CRE 0.0005","45","Select","Select",""],["","69452015020","VALPROIC ","CAP 250MG","120","Select","Select",""],["","781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","43547028950","BUPROPION ","TAB 150MG SR","30","Select","Select",""],["","55111053401","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","168016215","CLOBETASOL ","OIN 0.0005","30","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","10147095303","PALIPERIDONE ","TAB ER 6MG","60","Select","Select",""],["","69047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","406048410","APAP\/CODEINE ","TAB 300-30MG","18","Select","Select",""],["","527128201","DICYCLOMINE ","TAB 20MG","30","Select","Select",""],["","65757040303","ARISTADA ","INJ 882MG\/3","3.2","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","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":""}]}]}