{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYLVIA C FRINK","gend":1,"add":"624  30TH STREET  ","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1984-12-09","age":"","mstatus":"","insh":11008597,"cliId":"8MC8J71HE63","pno":7573999573,"cno":7573999573,"email":"","ename":"","eno":"","pphy":"ELLIOTT, JOY SPENCE  ","ppno":7575943800,"pcpadd":"10510 Jefferson Ave Ste A","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236013102,"pcpcounty":"","pcpid":"P9059005","pcpname":"RIVERSIDE BRENTWOOD MEDICAL CENTER FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"624  30TH STREET  ","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23607-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F25.9","F20.9","Z79.899","Z11.59","M54.2","M54.6","M54.5","M25.511","F20.0","F33.1","Z23","F32.9","F17.200","Z11.3","Z12.4","E78.5","Z13.1","Z13.228","J06.9","R05","J02.9","R21","F17.210","Z79.1","F29","S40.012A","M25.512","V03.10XA","Y93.01","M25.552","S40.022A","S79.912A","S49.92XA","V09.20XA","Y92.414","S39.012A","Z00.00","V89.2XXA","F25.0","F41.1","F33.0","K59.09","E66.9","Z68.31","R06.02","L40.9","L30.9","L98.9","R44.3","Z74.3","T16.2XXA"],"date":["2021-10-20","2021-09-10","2020-10-27","2020-08-06","2019-09-27","2019-09-27","2021-04-08","2019-09-27","2019-09-26","2020-09-10","2019-09-26","2019-09-26","2019-09-26","2020-10-05","2020-10-05","2019-10-11","2019-10-11","2019-10-11","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-09-10","2020-10-27","2020-12-17","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-02-11","2021-01-29","2021-04-08","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-10-27","2021-04-08","2021-06-11","2021-06-11","2021-09-10","2021-09-10","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":[["","228212710","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","13668013705","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","50458030711","RISPERDAL","INJ 37.5MG","","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","","Select","Select",""],["","713075937","BETAMETH DIP","CRE 0.0005","","Select","Select",""],["","591544305","PREDNISONE","TAB 20MG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","","Select","Select",""],["","50458030711","RISPERDAL ","INJ 37.5MG","1","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","228212750","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","65162019010","NAPROXEN ","TAB 500MG","28","Select","Select",""],["","713075937","BETAMETH ","CRE 0.0005","45","Select","Select",""],["","591544305","PREDNISONE ","TAB 20MG","4","Select","Select",""],["","45802006435","TRIAMCINOLON ","0.10%","15","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","90","Select","Select",""],["","45802006435","TRIAMCINOLON","0.001","15","Select","Select",""],["","00713075937","BETAMETH","0.0005","45","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":""}]}]}