{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YVONNE M MORRISSETTE","gend":1,"add":"800 DAPHIA CIRCLE ","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1948-12-09","age":"","mstatus":"","insh":11003394,"cliId":"4UJ1DH9EE19","pno":8609179012,"cno":8609179012,"email":"","ename":"","eno":"","pphy":"CROSSEN, DAVID K  ","ppno":8044217404,"pcpadd":"7605 Forest Ave Ste 316","pcpcity":"Henrico  ","pcpstate":"VA","pcpzip":232294939,"pcpcounty":"","pcpid":"P9307331","pcpname":"CROSSEN FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"800 DAPHIA CIRCLE ","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23601-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I48.20","I48.2","N32.81","N39.41","I48.1","I10","R60.9","I48.91","E03.9","Z86.19","R42","E78.00","K21.9","Z79.01","H90.3","N28.9","R22.1","I48.21","I35.1","M79.604","M79.605","Z23","Z00.00","Z12.31","R39.81","E78.2","E66.01","E78.5","H93.11","I50.9","Z68.35","Z79.899","R73.9","E66.9","Z68.30","I65.21","E87.6","R11.0","I11.0","H90.5","M19.90","Z96.659","L97.929","I73.9","G89.29","H26.9","I87.309","J30.9","M48.00","N18.9","R26.9","Z77.22","Z82.49","Z82.5","Z91.81","Z98.890","H25.13","H57.13","H40.013","Z01.810","H25.12","I50.30","Z88.8","Z80.9","H25.11","Z98.42","Z96.1","N30.01","R51.9","R68.83","R19.7","W06.XXXA","B96.20","S00.212A","S70.02XA","S70.01XA","Z20.822","S09.90XA","R07.9","Z13.220","I89.0","I08.0","Z51.81","R10.9","R82.90","M54.50","S30.1XXA","S29.9XXA","Y92.009","W01.190A","S20.219A","Z79.890","S32.019A","S22.31XA"],"date":["2021-11-03","2019-09-16","2021-02-12","2021-02-12","2019-03-06","2021-11-13","2019-03-26","2021-08-11","2021-11-13","2019-03-06","2019-08-20","2021-07-13","2019-11-18","2021-11-13","2019-03-06","2019-06-27","2019-03-06","2021-10-06","2021-05-20","2019-03-25","2019-03-25","2019-03-26","2021-03-31","2018-04-02","2018-04-23","2021-10-06","2019-08-20","2019-08-20","2018-06-25","2019-08-20","2018-06-25","2021-11-13","2019-06-27","2019-06-27","2019-06-27","2018-07-09","2019-08-20","2019-08-07","2019-12-02","2019-08-07","2019-12-02","2019-12-02","2018-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2021-03-31","2018-08-21","2019-10-24","2019-09-23","2019-09-26","2019-11-15","2019-11-18","2019-12-02","2021-11-13","2019-12-02","2019-12-02","2019-12-02","2019-12-02","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-03-31","2021-05-20","2021-07-02","2021-11-03","2021-11-13","2021-10-06","2021-10-06","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13"],"priorHcc":[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":[["","527134501","LEVOTHYROXIN","TAB 100MCG","","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","57237010199","METOPROL TAR","TAB 50MG","","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","68462047205","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","93171301","WARFARIN","TAB 2MG","","Select","Select",""],["","24208043405","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","93720298","PRAVASTATIN","TAB 40MG","","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","60758077305","KETOROLAC","SOL 0.004","","Select","Select",""],["","42806001410","MECLIZINE","TAB 25MG","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","64380086106","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","527134501","LEVOTHYROXIN ","TAB 100MCG","90","Select","Select",""],["","378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","60505017007","PRAVASTATIN ","TAB 40MG","90","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","90","Select","Select",""],["","68462047205","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","93171301","WARFARIN ","TAB 2MG","60","Select","Select",""],["","24208043405","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","60758011910","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","60758077305","KETOROLAC ","SOL 0.004","5","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","42806001410","MECLIZINE ","25MG","30","Select","Select",""],["","64380086106","POT  CHLORIDE","10MEQ ER","30","Select","Select",""],["","57664047758","METOPROL","50MG","90","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","",""],["Yes","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":""}]}]}