{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA WINFIELD","gend":1,"add":"1116 WILCOX AVENUE","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1982-10-24","age":"","mstatus":"","insh":11013950,"cliId":"6P39HY5MK39","pno":7579274022,"cno":7579274022,"email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA A","ppno":7574465955,"pcpadd":"1701 High St, Fl 1","pcpcity":"Portsmouth","pcpstate":"VA","pcpzip":237043103,"pcpcounty":"","pcpid":"P9058629","pcpname":"EVMS MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1116 WILCOX AVENUE","madd2":"","madd3":"","mcity":"PORTSMOUTH","mstate":"VA","mzip":"23704-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F33.1","F31.9","E11.65","E55.9","E53.8","Z98.84","E78.5","G43.909","L68.0","I10","E11.42","M10.9","R19.7","G47.33","E66.01","E11.9","Z99.89","M54.9","G89.4","J00","F41.9","F90.0","E28.2","Z83.49","L23.6","Z13.89","M23.261","M17.11","E66.09","L20.9","Z23","J45.909","M17.0","H10.9","J32.9","M54.5","H43.393","H16.223","M22.2X1","M22.2X2","M79.18","J30.9","Z12.4","Z30.9","Z11.3","Z68.43","M23.231"],"date":["2021-07-01","2021-06-20","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-06-08","2020-06-11","2021-04-28","2021-06-08","2021-05-21","2021-04-28","2020-06-29","2020-06-29","2021-04-28","2021-06-08","2020-06-29","2021-06-08","2020-07-22","2021-06-08","2021-06-08","2021-06-08","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2020-07-31","2020-07-31","2021-02-09","2021-06-08","2020-10-20","2021-06-08","2020-11-09","2020-12-03","2020-12-03","2021-03-26","2021-01-19","2021-01-19","2021-04-06","2021-02-09","2021-02-09","2021-02-12","2021-02-22","2021-02-22","2021-02-23","2021-04-06","2021-04-06"],"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":[["","67877056305","METFORMIN","TAB 1000MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","406012405","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","555097402","AMPHET\/DEXTR","TAB 30MG","","Select","Select",""],["","67877024601","QUETIAPINE","TAB 200MG","","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","2143480","TRULICITY","INJ 1.5\/0.5","","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","11917002529","INSULIN SYRG","MIS 1ML\/30G","","Select","Select",""],["","55111029309","SUMATRIPTAN","TAB 100MG","","Select","Select",""],["","115180401","HYDROXYZ PAM","CAP 50MG","","Select","Select",""],["","93005401","BUSPIRONE","TAB 10MG","","Select","Select",""],["","591042405","TRIAMT\/HCTZ","TAB 37.5-25","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","228203150","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","","Select","Select",""],["","24208079062","NEO\/POLY\/GRA","SOL OP","","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","31722088530","ROSUVASTATIN","TAB 40MG","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","54418425","DEXAMETHASON","TAB 4MG","","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","","Select","Select",""],["","591544305","PREDNISONE","TAB 20MG","","Select","Select",""],["","8290320550","BD PEN NEEDL","MIS 32GX5\/32","","Select","Select",""],["","472037915","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","406012405","HYDROCO\/APAP ","TAB 7.5-325","120","Select","Select",""],["","555097402","AMPHET\/DEXTR ","TAB 30MG","60","Select","Select",""],["","53885014301","ONETOUCH ","MIS LANCETS","100","Select","Select",""],["","67877024601","QUETIAPINE ","TAB 200MG","90","Select","Select",""],["","67877056305","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","2143480","TRULICITY ","INJ 1.5\/0.5","6","Select","Select",""],["","16729000517","SIMVASTATIN ","TAB 20MG","90","Select","Select",""],["","55111029309","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","90","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","68382013805","TOPIRAMATE ","TAB 25MG","90","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","28","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","11917002529","INSULIN ","MIS 1ML\/30G","10","Select","Select",""],["","24208079062","NEO\/POLY\/GRA ","SOL OP","10","Select","Select",""],["","591042405","TRIAMT\/HCTZ ","TAB 37.5-25","90","Select","Select",""],["","115180401","HYDROXYZ ","CAP 50MG","90","Select","Select",""],["","93005401","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","69097084805","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","228203150","ALPRAZOLAM ","TAB 1MG","60","Select","Select",""],["","54418425","DEXAMETHASON ","TAB 4MG","9","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","90","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","591544305","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","43547028910","BUPROPION ","TAB 150MG SR","360","Select","Select",""],["","69238117109","DOXEPIN ","50MG","90","Select","Select",""],["","8290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","31722088530","ROSUVASTATIN ","40MG","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":[[["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":""}]}]}