{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELPHINE FORDHAM","gend":1,"add":"944 QUASH ST","city":"HAMPTON  ","state":"VA","zip":"23669-9998","dob":"1963-09-28","age":"","mstatus":"","insh":11016064,"cliId":"5W35AC8MU87","pno":7577621127,"cno":7577621127,"email":"","ename":"","eno":"","pphy":"DELAHOUSSAYE, ALADEE R  ","ppno":7578748400,"pcpadd":"4714 Marshall Ave","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236072247,"pcpcounty":"","pcpid":"P9058686","pcpname":"HAMPTON NEWPORT NEWS COMMUNITY SERVICE BOARD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"944 QUASH ST","madd2":"","madd3":"","mcity":"HAMPTON  ","mstate":"VA","mzip":"23669-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["A59.01","N30.00","M54.89","J01.00","Z20.828","Z01.84","J45.998","Z23","R69","F31.9","M54.41","M54.5","M79.644","Z88.5","Z88.8","F17.210","M54.9"],"date":["2021-01-11","2021-01-11","2021-02-05","2021-02-17","2021-02-17","2020-12-30","2020-12-30","2020-12-30","2021-11-22","2021-10-25","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06"],"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":[["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","603533932","PREDNISONE","TAB 20MG","","Select","Select",""],["","64980012460","DIFLORASONE","OIN 0.0005","","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","64980012460","DIFLORASONE ","OIN 0.0005","360","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","603533932","PREDNISONE ","TAB 20MG","21","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","20","Select","Select",""],["","70010075401","METHOCARBAM","500MG","20","Select","Select",""],["","65162062711","TRAMADOL","50MG","15","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","69238110005","DOXYCYCL","100MG","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":[[["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":""}]}]}