{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MOZELLE A FIELDS","gend":1,"add":"PATRICE ROLLINS","city":"VIRGINIA BEACH ","state":"VA","zip":"23464-3615","dob":"1932-10-09","age":"","mstatus":"","insh":11005586,"cliId":"4P00V29YN19","pno":8044480668,"cno":8044480668,"email":"","ename":"","eno":"","pphy":"ESSAH, PAULINA A","ppno":8047989208,"pcpadd":"306 Ashcake Rd Ste C","pcpcity":"Ashland  ","pcpstate":"VA","pcpzip":230052323,"pcpcounty":"Hanover","pcpid":"P0149257","pcpname":"BON SECOURS INTERNAL MEDICINE OF ASHLAND","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"6405AUBURN DRIVE APT 234","add3":"","madd1":"PATRICE ROLLINS","madd2":"6405AUBURN DRIVE APT 234","madd3":"","mcity":"VIRGINIA BEACH ","mstate":"VA","mzip":"23464-3615","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F03.90","S06.349D","R44.3","G30.1","F02.80","Z68.20","I10","R53.1","R53.81","R69","J30.9","R09.82","Z20.828","Z01.84","H40.1132","H35.3130","Z96.1","M54.5","W18.30XA","S00.03XA","M81.0","J45.20","Z86.73","E55.9","R73.02","E78.2","Z68.22","H40.9","J45.909","G30.9","N39.46","M19.90","R29.6","N32.81","Z23","Z78.0","S09.90XA","W06.XXXA","R51","R41.0","I25.10","Z79.899","S09.90XD","M25.473","W19.XXXD","M25.471","Z13.31","Z78.9","M25.472","Z00.00","B35.1","M79.674","M79.675","Z68.23","Z68.25","Z68.24","M20.42","M20.41","R22.0","R06.02","N76.0","B96.89","F02.81","Z68.26","L60.0"],"date":["2020-09-28","2021-08-04","2021-08-04","2021-08-04","2021-06-11","2019-10-11","2021-06-11","2021-05-02","2021-09-13","2021-03-29","2019-10-11","2019-10-11","2020-10-13","2020-10-13","2021-06-17","2020-12-17","2020-12-17","2019-02-11","2018-12-13","2018-12-13","2021-06-11","2020-11-04","2020-01-10","2021-03-10","2020-05-18","2020-05-18","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2019-02-11","2019-07-29","2019-05-13","2019-03-22","2019-04-22","2019-04-22","2019-04-22","2019-04-22","2019-04-22","2019-04-22","2019-04-25","2019-04-25","2019-04-25","2019-06-10","2021-06-11","2020-06-12","2019-06-10","2021-06-11","2021-11-09","2021-11-09","2021-11-09","2020-07-06","2020-11-04","2021-03-10","2021-03-29","2021-03-29","2020-06-12","2020-06-12","2021-06-11","2021-06-11","2021-08-04","2021-08-04","2021-11-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","68180023007","MEMANTINE","TAB HCL 10MG","","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","","Select","Select",""],["","469260130","MYRBETRIQ","TAB 25MG","","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","","Select","Select",""],["","65862032804","ALENDRONATE","TAB 35MG","","Select","Select",""],["","603497528","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","","Select","Select",""],["","60505265601","TRIAMT\/HCTZ","TAB 37.5-25","","Select","Select",""],["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","","Select","Select",""],["","68180023007","MEMANTINE ","TAB HCL 10MG","60","Select","Select",""],["","93206301","QUETIAPINE ","TAB 25MG","30","Select","Select",""],["","469260130","MYRBETRIQ ","TAB 25MG","30","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","90","Select","Select",""],["","60505265601","TRIAMT\/HCTZ ","TAB 37.5-25","90","Select","Select",""],["","65862032804","ALENDRONATE ","TAB 35MG","4","Select","Select",""],["","603497528","OXYBUTYNIN ","TAB 5MG","60","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","68180051901","LISINOP\/HCTZ ","TAB 20-12.5","180","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","65862007601","CIPROFLOXACN ","TAB 250MG","14","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","57664050658","METOPROL","25MG","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","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","",""],["No","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":""}]}]}