{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TUREZA SIMPSON","gend":0,"add":"2704 HICKORY ST","city":"PORTSMOUTH  ","state":"VA","zip":"23707-4228","dob":"1969-09-25","age":"","mstatus":"","insh":11003775,"cliId":"5PG5C01KF78","pno":7573939557,"cno":7573939557,"email":"","ename":"","eno":"","pphy":"WHALEN, RICHARD M ","ppno":7574465955,"pcpadd":"825 Fairfax Ave,Ste 118","pcpcity":"Norfolk  ","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"P9058669","pcpname":"GHENT FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2704 HICKORY ST","madd2":"","madd3":"","mcity":"PORTSMOUTH  ","mstate":"VA","mzip":"23707-4228","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F20.9","F31.60","Z68.36","E66.9","Z72.0","E11.65","R53.83","M79.642","Z79.84","F17.200","I10","J44.9","Z79.899","E11.9","J40","F31.9","G47.00","Z76.0","Z86.59","F17.210","K21.9","K59.00","F10.10","J45.909","R05","Z71.6","R10.9","Z20.828","Z00.00","Z83.3","F25.9","Z12.11","F10.21","R39.198","J43.2","F10.20"],"date":["2021-10-26","2020-01-03","2021-06-15","2020-01-03","2021-09-09","2020-03-11","2020-03-11","2020-03-11","2020-04-02","2021-06-15","2020-03-11","2020-03-11","2020-04-02","2021-09-09","2020-03-11","2021-03-24","2021-10-26","2021-03-24","2020-04-02","2020-04-02","2020-12-16","2018-08-31","2020-12-01","2021-05-06","2019-11-13","2019-11-13","2018-10-24","2021-01-12","2018-12-13","2018-12-13","2018-12-13","2021-09-09","2021-09-09","2021-06-15","2021-09-09","2021-10-26"],"priorHcc":[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":[["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","","Select","Select",""],["","93816301","QUETIAPINE","TAB 200MG","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","378240201","TRIFLUOPERAZ","TAB 2MG","","Select","Select",""],["","115148901","AMPHET\/DEXTR","CAP 20MG ER","","Select","Select",""],["","14539067401","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","13668000805","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","93816301","QUETIAPINE ","TAB 200MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","378240201","TRIFLUOPERAZ ","TAB 2MG","60","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","180","Select","Select",""],["","115148901","AMPHET\/DEXTR ","CAP 20MG ER","30","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","14539067401","HYDROXYZ ","25MG","14","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","90","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","90","Select","Select",""],["","14539067401","HYDROXYZ","25MG","14","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","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","",""],["Yes","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":""}]}]}