{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA V REYES","gend":1,"add":"4835 DOLTON DRIVE ","city":"VIRGINIA BEACH ","state":"VA","zip":"23462-4408","dob":"1958-09-27","age":"","mstatus":"","insh":11009618,"cliId":"6UJ5C67JD50","pno":7577480914,"cno":7577480914,"email":"","ename":"","eno":"","pphy":"GONZALES, NORMAN  ","ppno":7574137600,"pcpadd":"5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH ","pcpstate":"VA","pcpzip":234644122,"pcpcounty":"","pcpid":"P9059051","pcpname":"SENTARA FAMILY MED PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"P.O. BOX 8745  ","add3":"","madd1":"4835 DOLTON DRIVE ","madd2":"P.O. BOX 8745  ","madd3":"","mcity":"VIRGINIA BEACH ","mstate":"VA","mzip":"23462-4408","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.65","E78.2","Z79.4","I10","E11.9","I25.10","I65.29","H81.10","R42","R27.0","I65.23","E11.21","I25.119","R30.0","N30.90","D22.9","M79.641","M25.552","Z12.31","C44.320","D48.5","L82.1","Z71.9","R10.32","N80.9","L98.9","F17.200","R10.2","M54.5","R10.84","K59.00","I25.2","Z95.5","Z90.710","Z88.0","Z88.8","Z79.02","Z87.891","C44.329","L90.5","Z76.89","M89.9","R10.9","B99.9","M65.341","N95.1","Z11.4","M67.40","Z01.818","R07.9","R53.1","R11.0","R53.83","R53.81","Z96.651","Z83.3","Z20.822","M67.441","R22.31","E78.5","Z79.899","Z79.82","R00.2"],"date":["2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-08-11","2021-10-22","2020-09-15","2020-10-12","2020-10-12","2020-10-12","2021-11-05","2021-01-29","2021-01-29","2020-12-24","2020-12-24","2020-12-24","2021-01-29","2020-12-28","2020-12-30","2021-01-08","2021-01-08","2021-01-08","2021-02-10","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-11-09","2021-02-08","2021-02-08","2021-02-08","2021-04-27","2021-04-27","2021-02-08","2021-04-27","2021-04-27","2021-04-27","2021-02-08","2021-02-10","2021-04-27","2020-12-24","2020-12-28","2021-02-08","2021-02-08","2021-04-29","2021-03-10","2021-03-10","2021-04-23","2021-04-14","2021-04-02","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2021-04-27","2021-04-27","2021-04-23","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-10-22"],"priorHcc":[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":[["","31722070190","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","93505798","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","6027754","JANUVIA","TAB 100MG","","Select","Select",""],["","68645057559","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","49281072010","FLUBLOK QUAD","INJ 2020-21","","Select","Select",""],["","8290320122","BD PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","","Select","Select",""],["","69047103","CHANTIX","PAK 0.5& 1MG","","Select","Select",""],["","93078701","ATENOLOL","TAB 25MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","68645057559","GLIPIZIDE ","TAB 10MG","180","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","45","Select","Select",""],["","8290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","93505798","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","68645059090","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","93078701","ATENOLOL ","TAB 25MG","90","Select","Select",""],["","31722070190","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","6027754","JANUVIA ","TAB 100MG","90","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0.5","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","69047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","70010010810","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","8","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","00088221905","LANTUS","100\/ML","45","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0.5","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","1","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","70010010810","GABAPENTIN","100MG","90","Select","Select",""],["","65162062711","TRAMADOL","50MG","8","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","6","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","",""],["Yes","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":""}]}]}