{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT C FORREST JR","gend":0,"add":"729 21ST STREET","city":"NEWPORT NEWS                  ","state":"VA","zip":"23607-9998","dob":"1944-08-26","age":"","mstatus":"","insh":11008621,"cliId":"3EP8QD0FC61","pno":7572326509,"cno":7572326509,"email":"","ename":"","eno":"","pphy":"REED, PAULINE                                               ","ppno":7572281288,"pcpadd":"940 General Booth Blvd Ste A,","pcpcity":"Virginia Beach                ","pcpstate":"VA","pcpzip":234514861,"pcpcounty":"","pcpid":"P0144882","pcpname":"WARWICK BOULEVARD PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"729 21ST STREET","madd2":"","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23607-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J18.9","J44.1","Z72.0","R09.81","F17.200","I12.9","I25.10","I25.2","N18.9","R73.03","Z95.5","Z79.82","Z79.84","R05","R06.02","E11.9","I10","J44.9","N52.9","Z13.9","Z12.5","Z12.11","R97.20","E78.00","M79.604","M79.651","E11.22","L02.511","M79.89","J45.909","M19.041","M19.042","L03.011","E11.69","M86.9","B95.62","E11.628","Z88.0","L08.9","T78.40XA","B96.4","M86.141","S60.942A","M19.91","F17.210","Z45.2","Z79.2","Z51.81","Z95.1","Z28.21","M25.641","M79.644","Z23","Z79.899","Z97.3","H52.203","E78.5","Z68.26","M25.551","K76.9","Z68.27"],"date":["2020-01-21","2020-01-06","2020-01-06","2020-01-06","2020-06-18","2020-07-24","2020-07-24","2020-06-18","2020-07-24","2020-06-14","2020-06-18","2020-11-24","2020-07-24","2020-01-06","2020-01-06","2020-08-13","2020-11-24","2020-08-13","2020-08-13","2020-01-21","2020-08-13","2020-08-13","2020-02-13","2020-08-13","2020-03-13","2020-03-13","2020-07-27","2020-11-04","2020-06-14","2020-11-24","2020-06-14","2020-06-14","2020-06-18","2020-06-18","2020-08-26","2020-07-27","2020-06-18","2020-06-18","2020-07-24","2020-06-18","2020-06-22","2020-07-27","2020-07-27","2020-07-24","2020-11-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-08-13","2020-11-04","2020-11-04","2019-09-20","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2019-12-05","2019-12-05","2019-12-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[]},{"a":[]}]},{"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":[["","31722070090","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","68645048054","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","0","VANCOMYCIN","INJ 10GM","","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","65162035109","SILDENAFIL","TAB 20MG","","Select","Select",""],["","53885099425","ONETOUCH","TES ULTRA BL","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","67877012405","SILVER SULFA","CRE 0.01","","Select","Select",""],["","67877022205","GABAPENTIN","CAP 100MG","","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","54001925","PREDNISONE","TAB 50MG","","Select","Select",""],["","59310030480","QVAR REDIHA","AER 80MCG","","Select","Select",""],["","43386043201","OXYCODONE","TAB 5MG","","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","","Select","Select",""],["","68645048054","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","68645057454","GLIPIZIDE ","TAB 5MG","30","Select","Select",""],["","173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","68645053959","METFORMIN ","TAB 500MG","30","Select","Select",""],["","0","VANCOMYCIN ","INJ 10GM","1","Select","Select",""],["","65162035109","SILDENAFIL ","TAB 20MG","60","Select","Select",""],["","59310030480","QVAR ","AER 80MCG","10.6","Select","Select",""],["","53885099425","ONETOUCH ","TES ULTRA BL","25","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","67877012405","SILVER ","CRE 0.01","50","Select","Select",""],["","43386043201","OXYCODONE ","TAB 5MG","40","Select","Select",""],["","67877022205","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","54001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","50111078710","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","17","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","31722070090","LOSARTAN","25MG","30","Select","Select",""],["","59310030480","QVAR","80MCG","10.6","Select","Select",""],["","00093317431","ALBUTEROL","E","17","Select","Select",""],["","67877012405","SILVER","0.01","50","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","",""],["No","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":""}]}]}