{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEISHAWN M KIAH","gend":0,"add":"468 NICHOLSON ST  ","city":"NORFOLK  ","state":"VA","zip":"23510-9998","dob":"1977-05-17","age":"","mstatus":"","insh":11010573,"cliId":"7D90H80GT42","pno":7572376194,"cno":"","email":"","ename":"","eno":"","pphy":"CHARLES F LOVELL JR MD PC  ","ppno":7576233038,"pcpadd":"142 W York St,Ste 905","pcpcity":"Norfolk  ","pcpstate":"VA","pcpzip":235102015,"pcpcounty":"","pcpid":"P9307291","pcpname":"CHARLES F LOVELL JR MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"468 NICHOLSON ST  ","madd2":"","madd3":"","mcity":"NORFOLK  ","mstate":"VA","mzip":"23510-9998","pcpfaxno":7576230101,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F84.0","F79","F63.9","E66.9","E55.9","Z12.5","I10","R73.09","E78.2","G47.30","H35.341","H52.12","R32","E11.9","H61.23","G47.33","G47.10","Z99.89"],"date":["2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-10-25","2020-06-05","2020-06-05","2021-04-19","2021-10-25","2020-06-05","2020-08-21","2020-08-21","2021-04-19","2021-10-25","2021-08-11","2021-11-12","2021-10-18","2021-11-12"],"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":[["","31722082030","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","62332008090","VALSART\/HCTZ","TAB 160-12.5","","Select","Select",""],["","60219106901","POT CHLORIDE","TAB 20MEQ ER","","Select","Select",""],["","68382009501","CARVEDILOL","TAB 25MG","","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","","Select","Select",""],["","60505258009","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","228306111","AMPHET\/DEXTR","CAP 30MG ER","","Select","Select",""],["","59746021601","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","832532511","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","64380080303","RANITIDINE","TAB 150MG","","Select","Select",""],["","31722082030","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","64380080303","RANITIDINE ","TAB 150MG","180","Select","Select",""],["","62332008090","VALSART\/HCTZ ","TAB 160-12.5","90","Select","Select",""],["","60219106901","POT  CHLORIDE","TAB 20MEQ ER","180","Select","Select",""],["","59746021601","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","68382009501","CARVEDILOL ","TAB 25MG","180","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","68180063709","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","228306111","AMPHET\/DEXTR ","CAP 30MG ER","30","Select","Select",""],["","55111015901","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","832532511","POT  CL MICRO","TAB 20MEQ ER","180","Select","Select",""],["","70010049101","METFORMIN","ORAL TAB","180","Select","Select",""],["","70010002703","TROSPIUM","60MG ER","90","Select","Select",""],["","70010002703","TROSPIUM ","CAP 60MG ER","90","Select","Select",""],["","31722015390","VALSARTAN ","TAB 160MG","90","Select","Select",""],["","70010049101","METFORMIN ","ER ORAL TAB","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":""}]}]}