{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH CANIPE","gend":1,"add":"29 CHANNING AVE","city":"PORTSMOUTH  ","state":"VA","zip":"23702-9998","dob":"1955-08-23","age":"","mstatus":"","insh":11014195,"cliId":"2QX4FJ7GM96","pno":7573925666,"cno":7575825896,"email":"","ename":"","eno":"","pphy":"SMITH-GRIFFIN, KIMBERLY ANN","ppno":4232243933,"pcpadd":"4124 Chesapeake Square Blvd Ste 1033","pcpcity":"Chesapeake  ","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"P0142101","pcpname":"SENTARA FAMILY AND INTERNAL MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"29 CHANNING AVE","madd2":"","madd3":"","mcity":"PORTSMOUTH  ","mstate":"VA","mzip":"23702-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["D05.12","D05.11","Z79.810","K51.20","J44.9","R21","R06.83","R53.83","Z13.9","E78.5","Z13.820","Z78.0","M81.0","G47.59","G47.10","G47.33","Z68.22","Z98.890","N64.4","R92.8","G57.52","F32.9","Z13.31","M25.572","Q66.72","M43.16","R20.0","R20.2","M54.5","G89.29","Z68.23","M47.816","M48.061","S33.140A","F51.01","G47.00","Z87.891","Z79.899","F31.30","H52.13","H52.4","H26.9","F90.9","K50.90","M06.9","M50.80","M48.00","Z92.21","D05.90","I45.10","Z68.24","I34.0"],"date":["2021-10-15","2020-10-12","2021-08-17","2021-01-15","2021-05-26","2021-01-25","2021-01-25","2021-01-25","2021-03-22","2021-05-26","2021-02-02","2021-02-02","2021-03-22","2021-04-21","2021-04-21","2021-04-21","2020-08-24","2020-10-13","2021-03-08","2021-03-08","2021-03-22","2021-05-14","2021-03-22","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-04-17","2021-03-24","2021-05-26","2021-04-17","2021-04-17","2021-04-17","2021-04-21","2021-05-14","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2021-05-26","2021-01-15","2021-05-26"],"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":[["","378014491","TAMOXIFEN","TAB 10MG","","Select","Select",""],["","45802005535","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","93505898","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","597007541","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","","Select","Select",""],["","93914801","VENLAFAXINE","TAB 37.5MG","","Select","Select",""],["","378014491","TAMOXIFEN ","TAB 10MG","90","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","30","Select","Select",""],["","93505898","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","50228018005","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","93914801","VENLAFAXINE ","TAB 37.5MG","90","Select","Select",""],["","597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","45802008801","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","69097022416","ALENDRONATE ","70MG","12","Select","Select",""],["","59310057922","PROAIR ","","8.5","Select","Select",""],["","59310057922","PROAIR","","8.5","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":""}]}]}