{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HARRIETTE B MANZIONE","gend":1,"add":"503 LAKE NAUASU","city":"VIRGINIA BEACH ","state":"VA","zip":"23454-9998","dob":"1947-02-24","age":"","mstatus":"","insh":11010855,"cliId":"9A39HT0FH47","pno":7577551025,"cno":7577551025,"email":"","ename":"","eno":"","pphy":"CHAI, SHIRLEY SOONGLEN  ","ppno":7573952500,"pcpadd":"1024 First Colonial Rd Ste 102","pcpcity":"Virginia Beach ","pcpstate":"VA","pcpzip":234543074,"pcpcounty":"","pcpid":"P0140861","pcpname":"SENTARA FAMILY MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"503 LAKE NAUASU","madd2":"","madd3":"","mcity":"VIRGINIA BEACH ","mstate":"VA","mzip":"23454-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K04.7","J30.89","F32.9","E78.00","I10","Z00.00","F17.210","Z12.39","Z23","F17.200","Z91.19","Z96.641","F41.9","F32.0","H25.813","J30.9","Z12.11","K02.9","K05.219","K08.89","B35.1"],"date":["2020-01-14","2020-07-23","2020-07-23","2021-07-26","2021-07-26","2020-08-17","2021-01-18","2020-08-17","2021-01-18","2021-07-26","2021-07-26","2021-07-26","2020-08-17","2021-07-26","2021-05-03","2021-01-18","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","93117401","PENICILLN VK","TAB 500MG","","Select","Select",""],["","93117401","PENICILLN ","TAB 500MG","28","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","781261305","AMOXICILLIN ","CAP 500MG","16","Select","Select",""],["","43547028211","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","31722070290","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","00093117401","PENICILLN","500MG","28","Select","Select",""],["","31722070290","LOSARTAN","100MG","90","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","40","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","40","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":""}]}]}