{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JARED T CHURCH","gend":0,"add":"225 W ONLEY RD #200  ","city":"NORFOLK  ","state":"VA","zip":"23510-9998","dob":"1996-01-05","age":"","mstatus":"","insh":11012988,"cliId":"2CT1Y87AC24","pno":7579495500,"cno":7577298050,"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":"Y","ano":"","add2":"","add3":"","madd1":"225 W ONLEY RD #200  ","madd2":"","madd3":"","mcity":"NORFOLK  ","mstate":"VA","mzip":"23510-9998","pcpfaxno":7576230101,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F20.9","F84.0","R45.851","F32.9","R45.4","F17.200","Z79.899","Z11.59","Z72.0","T14.91XA","Z74.3","F33.1","F17.210","F70","F39","F90.0","F41.9","H91.93","Z23","J30.9","F90.9","H92.02"],"date":["2021-11-14","2021-07-19","2020-06-11","2020-06-12","2020-06-11","2020-06-12","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-12","2020-06-15","2021-01-13","2021-01-13","2021-07-19","2021-07-19","2021-04-19","2021-04-19","2020-08-05","2020-08-05","2020-08-05"],"priorHcc":[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":[["","51991081403","AZELASTINE","SPR 0.001","","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","","Select","Select",""],["","93816601","QUETIAPINE","TAB 50MG","","Select","Select",""],["","832030400","CHLORPROMAZ","TAB 200MG","","Select","Select",""],["","42806034501","AMPHET\/DEXTR","TAB 30MG","","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","","Select","Select",""],["","51525029403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","43547034206","RISPERIDONE ","TAB 2MG","90","Select","Select",""],["","832030400","CHLORPROMAZ ","TAB 200MG","90","Select","Select",""],["","14539067501","HYDROXYZ ","CAP 50MG","90","Select","Select",""],["","93816601","QUETIAPINE ","TAB 50MG","90","Select","Select",""],["","42806034501","AMPHET\/DEXTR ","TAB 30MG","20","Select","Select",""],["","14539067501","HYDROXYZ","50MG","90","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","",""],["No","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":""}]}]}