{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MYKLLE A THOMPSON","gend":0,"add":"3700 SUMMER PLACE ","city":"VIRGINIA BEACH ","state":"VA","zip":"23453-9998","dob":"1975-02-11","age":"","mstatus":"","insh":11016232,"cliId":"2N30U14WE45","pno":7573863082,"cno":7573863082,"email":"","ename":"","eno":"","pphy":"HAMBAZ, NASSER ","ppno":7576717777,"pcpadd":"4876 Baxter Rd","pcpcity":"Virginia Beach ","pcpstate":"VA","pcpzip":234624404,"pcpcounty":"","pcpid":"P0060179","pcpname":"FIRST CHOICE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1016 Outerbridge Quay","madd2":"","madd3":"","mcity":"Virginia Beach ","mstate":"VA","mzip":"23464-8200","pcpfaxno":7578537377,"pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["L63.9","M79.676","L03.039","L60.0","F84.5","I10","E55.9","Z20.9","Z00.01","M25.571","F34.1","M79.672","M25.572","T14.8XXA","F70","F90.0","F90.9","E78.5","Z23","M17.12","M25.562"],"date":["2021-10-12","2021-10-05","2021-10-05","2021-10-05","2021-09-14","2021-09-14","2021-09-14","2021-02-01","2021-02-11","2021-02-26","2021-08-13","2021-03-22","2021-04-08","2021-04-08","2021-11-10","2021-08-13","2020-10-05","2021-09-14","2021-09-09","2021-11-11","2021-11-11"],"priorHcc":["","","","","","","","","","","","","","",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":[["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","50383026650","CLOBETASOL","SOL 0.0005","","Select","Select",""],["","378135201","TRIAMT\/HCTZ","TAB 37.5-25","","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","68382011205","RISPERIDONE","TAB 0.25MG","","Select","Select",""],["","65162075550","DIVALPROEX","TAB 250MG ER","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","50383026650","CLOBETASOL ","SOL 0.0005","50","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","65162075550","DIVALPROEX ","TAB 250MG ER","84","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","28","Select","Select",""],["","68382011205","RISPERIDONE ","TAB 0.25MG","28","Select","Select",""],["","378135201","TRIAMT\/HCTZ ","TAB 37.5-25","28","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":""}]}]}