{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA J CAMPBELL","gend":1,"add":"311 70TH STREET","city":"NEWPORT NEWS                  ","state":"VA","zip":"23607-9998","dob":"1952-09-20","age":"","mstatus":"","insh":11012655,"cliId":"8PU0KR3KT08","pno":7573591072,"cno":7573591072,"email":"","ename":"","eno":"","pphy":"BALKA, AMY","ppno":7572387043,"pcpadd":"13478 CARROLLTON BLVD,","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":233143208,"pcpcounty":"","pcpid":"P9058598","pcpname":"EAGLE HARBOR PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"311 70TH STREET","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23607-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z51.81","Z79.01","I67.89","J20.9","J01.90","E11.65","Z79.84","Z87.891","M79.89","R31.9","I10","R05","R26.89","Z86.73","R06.09","E78.5","R60.0","I34.0","Q21.1","E11.9","I69.354","E78.2","G47.30","K21.9","J45.909","Z88.1","Z88.8","Z91.013","Z79.899","Z79.82","I63.9","Z00.00","M17.0","E55.9","R26.9","G47.00","M79.604","M79.605","Z12.31","R10.84","N30.01","Z87.19","G47.33","G47.61","M79.645","G25.81","R51.9","Z20.828","Z74.3","Q24.9","R27.0","Z03.89","R29.818","G93.89","K11.7","R47.9","M19.142","W22.09XS","M79.642","M19.90","M18.12","M19.042","Z99.89","R07.89","Z68.41","R29.810","R53.1","E66.9","Z96.1","I25.10","M25.562","I63.411","M17.12","Z01.818","M25.561","R06.00","M79.602","R10.30","K57.30","K65.4","Z90.710","E66.01","G89.18","Z47.1","Z96.652","I95.9","M17.11","M25.462","J47.9","Q34.8","J32.9","R10.2","F41.1","Q44.2","K56.609","G89.29","R30.0","M25.511","Q24.8","K83.1","R63.4","K85.90","R10.13","M19.011","R06.02","N83.202","R10.9","R74.8","B37.0","N39.0","E84.9","K86.1","Q89.09","Z90.49","M75.01","M75.101","Z20.9","N83.209","E78.01","R10.32","R06.2","R11.2","Q26.9","Q89.3","Z20.822","B37.3","N83.8","N83.292","K56.1","Z98.890","R68.89","R07.9","Z87.74","Z87.738","R19.7","N80.3","N80.0","N80.8","R42","N93.9","R11.10","N80.9","R11.0"],"date":["2021-10-06","2021-10-06","2020-08-07","2020-04-28","2021-09-17","2021-04-08","2021-07-26","2021-07-26","2020-12-07","2020-06-09","2021-07-26","2021-08-30","2020-07-07","2021-07-26","2020-07-23","2021-07-26","2020-07-23","2021-06-24","2021-06-15","2021-07-26","2020-12-11","2021-06-15","2021-08-04","2021-07-26","2021-05-13","2021-05-03","2021-05-03","2021-05-03","2021-07-26","2021-07-26","2021-10-06","2020-09-08","2021-09-16","2020-09-08","2020-10-20","2020-12-07","2020-10-07","2021-02-26","2020-09-16","2021-08-18","2020-10-14","2021-09-22","2021-08-16","2020-11-29","2020-12-07","2020-12-07","2020-12-11","2020-12-11","2020-12-11","2021-06-24","2020-12-11","2020-12-11","2020-12-12","2020-12-11","2020-12-15","2020-12-15","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-02-02","2021-02-02","2021-02-11","2021-04-08","2021-05-06","2020-12-11","2020-12-11","2021-05-03","2020-12-24","2021-06-15","2021-08-10","2021-03-17","2021-09-16","2021-06-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-05-03","2021-05-06","2021-05-06","2021-09-16","2021-09-16","2021-05-07","2021-05-13","2021-05-24","2021-06-28","2021-07-21","2021-06-14","2021-10-09","2021-10-05","2021-08-15","2021-09-16","2021-06-22","2021-06-23","2021-08-17","2021-06-24","2021-06-28","2021-06-28","2021-06-28","2021-09-22","2021-08-24","2021-09-22","2021-09-16","2021-09-30","2021-09-22","2021-08-15","2021-08-15","2021-09-22","2021-08-15","2021-08-15","2021-09-22","2021-08-10","2021-08-27","2021-08-18","2021-08-18","2021-06-28","2021-09-30","2021-08-11","2021-09-30","2021-07-21","2021-09-22","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-16","2021-10-05","2021-09-17","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-24","2021-09-24","2021-09-24","2021-09-30","2021-09-30","2021-09-30","2021-10-05","2021-10-09"],"priorHcc":[null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","",null,null,"","","","","","","","","","","","","",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":[["","23155010205","METFORMIN","TAB 500MG","","Select","Select",""],["","60505014101","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","16714074703","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","16714087602","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","42423027101","ALCOHOL PREP","PAD MED 70%","","Select","Select",""],["","781207410","TRIAMT\/HCTZ","CAP 37.5-25","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","","Select","Select",""],["","65862051205","PIOGLITAZONE","TAB 15MG","","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","","Select","Select",""],["","16714097601","DICLOFENAC","GEL 0.01","","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","68462043730","OLMESA MEDOX","TAB 20MG","","Select","Select",""],["","93172101","WARFARIN","TAB 5MG","","Select","Select",""],["","62332014231","CELECOXIB","CAP 200MG","","Select","Select",""],["","8290326895","BD SWAB REG","PAD SNGL USE","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","781207410","TRIAMT\/HCTZ ","CAP 37.5-25","90","Select","Select",""],["","23155010205","METFORMIN ","TAB 500MG","360","Select","Select",""],["","65862019399","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","93505898","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","180","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","67877022210","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68645014059","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","16714074703","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","180","Select","Select",""],["","51672403201","WARFARIN ","TAB 5MG","180","Select","Select",""],["","65862051205","PIOGLITAZONE ","TAB 15MG","90","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","62332014231","CELECOXIB ","CAP 200MG","90","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","16714097601","DICLOFENAC ","GEL 0.01","300","Select","Select",""],["","65702028810","FASTCLIX ","MIS LANCETS","408","Select","Select",""],["","42423027101","ALCOHOL ","PAD MED 70%","400","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","25.5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","93319653","CEFADROXIL ","CAP 500MG","14","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","60","Select","Select",""],["","65702040810","ACCU-CHEK ","TES AVIVA PL","200","Select","Select",""],["","68462043790","OLMESA ","TAB 20MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","8290326895","BD ","PAD SNGL USE","400","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59310057922","PROAIR ","","8.5","Select","Select",""],["","00093101042","MUPIROCIN","0.02","22","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","68462043790","OLMESA","20MG","90","Select","Select",""],["","42423027101","ALCOHOL","MED 70%","400","Select","Select",""],["","00093319653","CEFADROXIL","500MG","14","Select","Select",""],["","10702001801","OXYCODONE","5MG","60","Select","Select",""],["","08290326895","BD","SNGL USE","400","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00143928501","AMOXICILLIN","875MG","20","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":""}]}]}