{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIE WOODLEY","gend":1,"add":"320 E MERCURY BLVD","city":"HAMPTON  ","state":"VA","zip":"23669-9998","dob":"1963-07-17","age":"","mstatus":"","insh":11005123,"cliId":"1C44PG0DR66","pno":7577035140,"cno":7578009809,"email":"","ename":"","eno":"","pphy":"JOHNSON, SHONNA","ppno":7578501311,"pcpadd":"191 Fox Hill Rd Ste D","pcpcity":"Hampton  ","pcpstate":"VA","pcpzip":236692360,"pcpcounty":"","pcpid":"P9058604","pcpname":"ELIZABETH LAKES FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"603 LASALLE AVE APT 25  ","madd2":"","madd3":"","mcity":"HAMPTON  ","mstate":"VA","mzip":"23669-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F20.9","F31.60","F70","E11.9","I10","R80.9","E78.5","M71.321","M71.322","M25.532","Z72.0","F25.0","R42","R11.10","F17.210","F31.9","Z79.899","R52","W19.XXXA","Y92.524","Z01.419","Z12.39","Z12.11","R11.0","M19.272","L60.0","R26.2","M77.9","B35.1","E11.40","M79.674","M79.675","Z12.31","R55","T67.9XXA","L84","L60.3","M25.572","M19.072","E11.51","R05","R11.2","K21.9","R19.4","K59.00","J45.901","E11.65","K62.5","Z00.00","J45.909","Z23","M70.21","M70.22","R09.89","Z68.25","Z79.82","M79.671","M79.672","R73.03","Z11.4","R53.83","Z86.19","H53.8","Z28.21","E66.3","N30.01","R53.81","R51","R15.9","R19.7","M54.9","H25.13","H52.13","H52.4","D12.4","K63.5","K64.8","M19.90","Z87.891","Z88.5","Z79.51","Z79.84","D12.5","K92.1","T78.40XA","F31.81","J44.9","R12","R01.1","Z53.20"],"date":["2021-04-20","2021-04-18","2021-04-18","2021-09-07","2021-09-07","2021-01-11","2021-09-07","2019-06-21","2019-06-21","2019-06-21","2021-07-08","2021-11-24","2021-07-08","2019-06-15","2020-04-22","2019-06-15","2021-04-20","2019-06-15","2019-06-15","2019-06-15","2021-08-11","2020-02-25","2021-04-21","2020-04-22","2019-12-18","2019-12-18","2019-10-09","2019-10-09","2021-08-25","2019-12-18","2019-07-03","2019-07-03","2021-09-24","2019-09-14","2019-09-14","2020-09-14","2021-06-04","2020-09-14","2020-09-14","2021-08-25","2019-10-15","2020-04-22","2021-01-11","2020-02-25","2021-04-20","2019-10-15","2021-01-11","2021-04-20","2020-10-28","2021-09-07","2021-09-07","2018-12-12","2018-12-12","2018-12-12","2018-12-12","2018-12-12","2019-12-18","2019-12-18","2019-01-04","2019-01-04","2019-01-04","2019-01-16","2019-01-16","2019-01-16","2020-02-25","2020-03-20","2020-03-20","2020-03-30","2020-03-30","2020-03-30","2021-01-11","2021-02-26","2021-02-26","2021-02-26","2021-04-21","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-09-19","2021-09-07","2021-07-08","2021-09-07","2021-09-10"],"priorHcc":["","","","","","","","","","","",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":[["","10572010001","PEG-3350","SOL ELECTROL","","Select","Select",""],["","69097094605","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","13668008190","MONTELUKAST","TAB 10MG","","Select","Select",""],["","68382041201","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","23155010201","METFORMIN","TAB 500MG","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","","Select","Select",""],["","55150026705","FLUPHENAZ DE","INJ 25MG\/ML","","Select","Select",""],["","59310058020","PROAIR RESPI","AER ","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","781207410","TRIAMT\/HCTZ","CAP 37.5-25","","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","","Select","Select",""],["","54001825","PREDNISONE","TAB 20MG","","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","13668008190","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","69097094605","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","68180051201","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","23155010201","METFORMIN ","TAB 500MG","60","Select","Select",""],["","68382041201","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","67877019905","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","59310058020","PROAIR ","AER ","1","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","90","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","54001825","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","67877031901","IBUPROFEN ","TAB 400MG","90","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","67457035959","FLUPHENAZ ","INJ 25MG\/ML","5","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","781207410","TRIAMT\/HCTZ ","CAP 37.5-25","30","Select","Select",""],["","67457035959","FLUPHENAZ","25MG\/ML","5","Select","Select",""],["","59310058020","PROAIR","","1","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","00006011254","JANUVIA","50MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","00006011254","JANUVIA ","TAB 50MG","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":""}]}]}