{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AVERY NEWTON","gend":0,"add":"800CENTER AVENUE  ","city":"NEWPORT NEWS","state":"VA","zip":"23605-1520","dob":"1961-07-17","age":"","mstatus":"","insh":11004426,"cliId":"9MW4R21MN76","pno":7575349244,"cno":7575349244,"email":"","ename":"","eno":"","pphy":"DOWLING, NEQUITA  ","ppno":7578271940,"pcpadd":"2148 W Mercury Blvd","pcpcity":"Hampton  ","pcpstate":"VA","pcpzip":236663111,"pcpcounty":"","pcpid":"P9059013","pcpname":"RIVERSIDE INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"800CENTER AVENUE  ","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23605-1520","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H04.123","H25.13","B18.2","E78.00","R73.03","Z23","F17.200","H93.11","J30.1","H93.291","J30.89","Z72.0","T63.441A","Y92.9","F17.210","Z91.030","L29.9","T78.2XXD","M47.812","M50.123","R20.2","M54.2","K57.90","M54.9","I10","M54.42","M54.41","M54.5","Z79.899","Z00.00","Z13.220","Z12.5","M17.11","G89.29","M25.561","M79.602","F17.219","Z12.2","I25.10","S80.862A","L08.9","K92.1","Z79.82","Z53.20"],"date":["2020-09-23","2020-09-23","2021-02-02","2021-05-26","2021-11-22","2019-05-06","2021-05-20","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2019-07-27","2019-07-27","2020-12-11","2020-11-04","2019-08-12","2019-09-06","2018-10-11","2018-10-11","2018-10-11","2018-11-05","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2021-02-02","2020-11-04","2020-11-16","2020-11-16","2021-11-22","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2021-02-02","2020-12-11","2021-02-02","2021-07-01","2021-07-01","2021-09-12","2021-09-12","2021-09-12"],"priorHcc":["","","","",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":[["","42806016005","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","70377000215","SIMVASTATIN","TAB 10MG","","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","591544305","PREDNISONE","TAB 20MG","","Select","Select",""],["","33332032001","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","70461031903","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","70377000215","SIMVASTATIN ","TAB 10MG","90","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","55111012305","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","591544305","PREDNISONE ","TAB 20MG","6","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","67877022005","CEPHALEXIN ","250MG","40","Select","Select",""],["","00093506110","HYDROXYZ","25MG","28","Select","Select",""],["","67877022005","CEPHALEXIN","250MG","40","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","70461031903","FLUCLVX","2019-20","0.5","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","00005197102","PREVNAR","","0.5","Select","Select",""],["","00005197102","PREVNAR ","INJ ","0.5","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":""}]}]}