{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THERESA COWELL","gend":1,"add":"40 GRADY CRES STREET APT 40","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1961-02-28","age":"","mstatus":"","insh":11016484,"cliId":"1T16X20JC71","pno":7576818072,"cno":7577621772,"email":"","ename":"","eno":"","pphy":"LANGAN, KATHLEEN","ppno":7573936363,"pcpadd":"3650 Joseph Siewick Dr, Suite 4000 Ste 400","pcpcity":"Fairfax","pcpstate":"VA","pcpzip":220331715,"pcpcounty":"","pcpid":"P9058911","pcpname":"NORFOLK REDEVELOPMENT AND HOUSING YOUNG TERRACE SE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APT 40","add3":"","madd1":"40 GRADY CRES STREET APT 40","madd2":"APT 40","madd3":"","mcity":"CHESAPEAKE","mstate":"VA","mzip":"23324-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I63.9","R39.81","E11.9","L22","Z46.89","M62.81","M21.372","N89.8","Z12.31","B35.6","N93.9","B99.9","I69.30","E11.65","R79.89","D72.829","M25.512","S49.92XA","R41.82","R51.9","R53.1","S09.90XA","R06.00","R29.6","R77.8","I10","Z86.73","Z99.3","R53.83","I69.354","E55.9","R82.71","R94.31","Z20.828","Z79.01","Z79.82","I51.7","I77.810","M62.838","E11.59","E11.69","B37.2","Z79.4","E78.5"],"date":["2021-07-01","2021-02-21","2021-03-21","2021-02-21","2020-11-05","2021-02-03","2020-11-03","2020-12-28","2021-01-04","2020-12-28","2020-12-28","2020-12-28","2021-03-21","2021-05-19","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-23","2021-03-21","2021-03-21","2021-03-30","2021-05-19","2021-05-19","2021-03-23","2021-03-23","2021-03-21","2021-05-19","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-03-22","2021-03-22","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-05-19"],"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":[["","43547027503","DONEPEZIL","TAB 5MG","","Select","Select",""],["","8214059080","PEN NEEDLES","MIS 31GX1\/4\"","","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","57237000299","HYDROCHLOROT","CAP 12.5MG","","Select","Select",""],["","73070020315","INS ASP PROT","INJ FLEXPEN","","Select","Select",""],["","65162037110","OXYBUTYNIN","TAB 5MG ER","","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","","Select","Select",""],["","70377002913","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","16729000316","GLIMEPIRIDE","TAB 4MG","","Select","Select",""],["","713067831","NYSTATIN","CRE 100000","","Select","Select",""],["","8214059080","PEN  NEEDLES  ","MIS 31GX1\/4\"","100","Select","Select",""],["","43547027503","DONEPEZIL ","TAB 5MG","90","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","4","Select","Select",""],["","16729000316","GLIMEPIRIDE ","TAB 4MG","180","Select","Select",""],["","57237000299","HYDROCHLOROT ","CAP 12.5MG","90","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","73070020315","INS ","INJ FLEXPEN","30","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","65162037110","OXYBUTYNIN ","TAB 5MG ER","90","Select","Select",""],["","713067831","NYSTATIN ","CRE 100000","30","Select","Select",""],["","52817032010","BACLOFEN ","10MG","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","",""],["Yes","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":""}]}]}