{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTIN G MCCORMICK","gend":0,"add":"110 SUBURBAN PKWY ","city":"NORFOLK  ","state":"VA","zip":"23505-9998","dob":"1953-01-02","age":"","mstatus":"","insh":11003584,"cliId":"1J95FT4PK65","pno":8088539970,"cno":8088539970,"email":"","ename":"","eno":"","pphy":"GRANT, THOMAS R","ppno":7574465955,"pcpadd":"825 Fairfax Ave,Hofheimer Hall 1st Floor Suite 118","pcpcity":"Norfolk  ","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"P0060129","pcpname":"GHENT FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"APT 208  ","add3":"","madd1":"110 SUBURBAN PKWY ","madd2":"APT 208  ","madd3":"","mcity":"NORFOLK  ","mstate":"VA","mzip":"23505-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","M25.551","M25.552","G47.00","L57.0","L30.8","Z85.828","E78.00","F17.210","F33.9","F41.1","F51.01","K08.109","M79.661","M79.671","Z68.26","Z79.899","Z85.820","Z97.2","Z98.49","L85.3","M16.0","Z00.00","F32.9","J44.9","I73.9","I47.1","F32.4","E78.5","G62.9","G89.29","J30.9","L40.9","Z79.1","Z80.9","Z82.49","L30.9","Z68.27","R00.2","R19.7","Z23","D69.2","I51.9","R20.2","K25.0","K92.2","N17.9","D62","M19.90","K22.70","K62.5","M10.9","K29.91","K57.30","E87.6","G31.84","F10.10","R07.9","R55","Z74.3","R57.1","K92.1","D50.0","R19.5","K20.90","K25.9","K29.70","D12.3","K63.5","R20.0","R00.0","R42","I51.89","Z13.31","F17.200","S91.309A","M79.672","X58.XXXA","Z01.818","I70.262","Z01.810","R94.31","I51.7","R01.1","R06.89","Z01.812","R91.8","Z20.822","I70.292","I70.245","L97.529","I70.202","I77.1","K21.9","I70.8","I65.29","Z79.82","Z79.02"],"date":["2021-08-11","2020-09-09","2020-09-09","2019-06-04","2019-07-22","2019-06-05","2021-04-16","2021-01-31","2021-08-11","2018-12-04","2021-01-31","2018-06-18","2018-06-18","2018-06-18","2018-06-18","2018-06-18","2021-08-11","2019-08-13","2018-06-18","2018-06-18","2019-07-01","2020-10-16","2021-04-16","2020-07-28","2019-08-13","2021-08-07","2019-08-13","2019-08-13","2019-08-13","2021-04-16","2019-08-13","2019-08-13","2019-08-13","2019-08-13","2019-08-13","2019-08-13","2020-10-23","2018-09-19","2018-10-01","2020-10-16","2020-10-16","2020-10-23","2018-12-04","2020-12-22","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-01","2021-02-01","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-02-02","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-02-01","2021-03-04","2021-02-03","2021-02-01","2021-04-16","2021-02-01","2021-02-03","2021-02-03","2020-12-22","2021-02-01","2021-04-16","2021-04-16","2021-04-16","2021-04-26","2021-05-03","2021-04-29","2021-04-29","2021-08-07","2021-05-03","2021-08-07","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-08-07","2021-08-07","2021-08-11","2021-08-11","2021-05-27","2021-05-27","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11"],"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":[["","65162010250","GABAPENTIN","CAP 300MG","","Select","Select",""],["","591333119","BUPROPN HCL","TAB 150MG XL","","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","","Select","Select",""],["","378001805","METOPROL TAR","TAB 25MG","","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","378668999","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","24591401","DUPIXENT","INJ 300\/2ML","","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","68180031909","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","60505265301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","90","Select","Select",""],["","378001805","METOPROL ","TAB 25MG","180","Select","Select",""],["","378668999","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","55111012390","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","24591401","DUPIXENT ","INJ 300\/2ML","4","Select","Select",""],["","45802005505","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","00378001805","METOPROL","25MG","180","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","65862035705","CLOPIDOGREL","75MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","20","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":""}]}]}