{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY L HATFIELD","gend":1,"add":"29369 SEASIDE RD  ","city":"CAPE CHARLES","state":"VA","zip":"23310-1665","dob":"1966-12-08","age":"","mstatus":"","insh":11010217,"cliId":"8TR5X86XH50","pno":7573500039,"cno":7573500039,"email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA K","ppno":7578245676,"pcpadd":"5219 LANKFORD HIGHWAY","pcpcity":"NEW CHURCH  ","pcpstate":"VA","pcpzip":234153332,"pcpcounty":"","pcpid":"P9058368","pcpname":"BAYVIEW COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","aligned":"Y","ano":"","add2":"","add3":"","madd1":"29369 SEASIDE RD  ","madd2":"","madd3":"","mcity":"CAPE CHARLES","mstate":"VA","mzip":"23310-1665","region":"TIDEWATER","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z01.419","M12.9","E55.9","D50.9","M79.89","J45.20","E66.01","Z68.41","E78.5","Z13.1","Z12.31","Z23","Z87.820","Z00.00","K21.9","B37.2","Z92.29","R42","R11.2","R51.9","H61.22","Z86.73","Z96.653","Z88.1","Z88.0","R27.0","S06.9X6S","R41.89","M17.11","M19.012","Z09","E66.09","Z68.42","Z71.3","M25.562","R22.42","Z96.652","S90.211A"],"date":["2020-01-03","2021-11-29","2021-11-02","2020-08-06","2020-09-11","2021-11-02","2020-09-11","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2020-10-16","2021-02-09","2021-04-27","2021-11-02","2021-04-27","2021-06-23","2021-06-15","2021-06-15","2021-06-15","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-06-30","2021-06-30","2021-06-30","2021-11-02","2021-06-30","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-09-30","2021-09-30","2021-09-30","2021-11-02"],"priorHcc":["",null,null,"","",null,"",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":[["","31722071310","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","43547027611","DONEPEZIL","TAB 10MG","","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","15","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","31722071310","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","68382005101","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","43547027611","DONEPEZIL ","TAB 10MG","30","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","172392680","DIAZEPAM ","5MG","12","Select","Select",""],["","51672128901","NYSTATIN","100000","15","Select","Select",""],["","00172392680","DIAZEPAM","5MG","12","Select","Select",""],["","00527217037","DICLOFENAC","100MG ER","30","Select","Select",""],["","00527217037","DICLOFENAC ","TAB 100MG ER","30","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":""}]}]}