{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLIE T POPE","gend":0,"add":"7525 TIDEWATER DR ","city":"VIRGINIA BEACH ","state":"VA","zip":"23462-9998","dob":"1969-12-13","age":"","mstatus":"","insh":11008724,"cliId":"7NU5PT9YF68","pno":7579611385,"cno":7579611385,"email":"","ename":"","eno":"","pphy":"HAMBAZ, NASSER ","ppno":7576717777,"pcpadd":"4876 Baxter Rd","pcpcity":"Virginia Beach ","pcpstate":"VA","pcpzip":234624404,"pcpcounty":"","pcpid":"P0060179","pcpname":"FIRST CHOICE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"7525 TIDEWATER DR ","madd2":"","madd3":"","mcity":"VIRGINIA BEACH ","mstate":"VA","mzip":"23462-9998","pcpfaxno":7578537377,"pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F31.4","B86","R21","Z00.00","L20.9","J00","Z12.11","Z11.1","F33.1","F70","F31.81","Z79.899","E70.0","R19.4","Z01.818","K63.5","R19.7","R10.9","K50.90","J45.909","F31.9","F84.0","K63.89","Z12.5","F31.32","F98.8","F66","K59.00","G31.84","Z68.28","R17","F84.5"],"date":["2021-11-19","2020-01-15","2020-02-05","2020-02-05","2020-02-12","2020-02-27","2020-02-27","2020-02-27","2020-11-30","2020-11-30","2020-11-30","2020-05-12","2020-03-05","2020-05-12","2020-05-08","2020-05-26","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2021-02-23","2020-05-12","2020-05-12","2020-05-28","2021-10-14","2020-11-24","2021-02-23","2020-01-16","2020-01-16","2020-01-16","2021-05-27","2021-10-14"],"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":[["","55111053301","DIVALPROEX","TAB 250MG ER","","Select","Select",""],["","55111025660","ZIPRASIDONE","CAP 20MG","","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","69097082707","BENZTROPINE","TAB 1MG","","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","10702001150","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","","Select","Select",""],["","55111025660","ZIPRASIDONE ","CAP 20MG","60","Select","Select",""],["","45802005505","TRIAMCINOLON ","OIN 0.001","454","Select","Select",""],["","55111053301","DIVALPROEX ","TAB 250MG ER","270","Select","Select",""],["","69097082707","BENZTROPINE ","TAB 1MG","270","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","120","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","10","Select","Select",""],["","70370204001","INGREZZA ","CAP 40MG","7","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","42806016005","HYDROXYZ","25MG","90","Select","Select",""],["","70370204001","INGREZZA","40MG","30","Select","Select",""],["","00093031101","LOPERAMIDE ","CAP 2MG","120","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":""}]}]}