{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE C BLAND","gend":1,"add":"409 TURLINGTON RD ","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1979-11-30","age":"","mstatus":"","insh":11009401,"cliId":"5KG4HX6WN03","pno":4348298604,"cno":4348298604,"email":"","ename":"","eno":"","pphy":"COCHRAN, DONALD L","ppno":7573971246,"pcpadd":"640 North St","pcpcity":"Portsmouth  ","pcpstate":"VA","pcpzip":237042415,"pcpcounty":"","pcpid":"P0140239","pcpname":"MD EXPRESS","ano":"","add2":"APT 7 ","add3":"","madd1":"409 TURLINGTON RD ","madd2":"APT 7 ","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23606-9998","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N30.00","R30.0","B37.9","M54.9","R10.2","R11.0","R19.7","R35.0","R39.15","F31.9","E11.9","I10","F20.0","F17.210","Z79.899","Z79.84","B00.9","Z11.3","N89.8","R03.0","B37.3","N30.01","E11.65","Z11.59","R31.9","R35.8","R10.32","Z87.440","Z20.2","E11.8","R07.89","R51.9","T50.905A","E07.9","Z12.4","R07.9","Z23","Z71.6","E66.9","Z68.42","S61.230A","S40.862A","W57.XXXA","Z00.01","M62.838","E66.01","M79.601","R20.0","F17.200","Z91.14","Z79.3","R39.9","N93.9","N92.6","Z01.419","Z87.42"],"date":["2020-01-26","2020-05-17","2020-03-30","2020-02-28","2021-11-09","2020-02-28","2020-02-28","2020-07-28","2020-02-28","2020-09-21","2021-08-10","2021-08-10","2020-09-21","2021-07-02","2021-08-10","2021-01-11","2020-03-30","2021-11-09","2021-11-09","2020-05-17","2021-07-02","2020-07-11","2021-07-10","2020-07-22","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-11-22","2020-11-22","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-12","2020-12-30","2020-12-30","2020-12-30","2021-08-02","2021-07-10","2021-07-10","2021-07-10","2021-08-02","2021-08-02","2021-08-02","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09"],"priorHcc":["","","","",null,"","","","","","","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[["","16729018201","HYDROCHLOROT ","TAB 12.5MG","90","Select","Select",""],["","59746036190","VALSARTAN ","TAB 80MG","90","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","120","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","31722070430","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","180","Select","Select",""],["","6057761","JANUMET ","TAB 50-1000","180","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","67877025130","TRIAMCINOLON ","0.001","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","59746036190","VALSARTAN","80MG","90","Select","Select",""],["","68382075810","METFORMIN","500MG","120","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","31722070430","VALACYCLOVIR","500MG","30","Select","Select",""],["","60505014201","GLIPIZIDE","10MG","60","Select","Select",""],["","00006057761","JANUMET","50-1000","180","Select","Select",""],["","67877025130","TRIAMCINOLON","0.001","30","Select","Select",""],["","51672130406","TERCONAZOLE","0.004","45","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","65162046650","IBUPROFEN","800MG","60","Select","Select",""],["","00832105515","BACLOFEN","20MG","180","Select","Select",""],["","00832105515","BACLOFEN ","TAB 20MG","180","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":"","a12":""}]}]}