{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY A EVANS","gend":1,"add":"1300 Parker Ave Apt B","city":"Portsmouth                    ","state":"VA","zip":"23704-4422","dob":"1955-07-20","age":"","mstatus":"","insh":11016961,"cliId":"5QE1AC8AY91","pno":7575175097,"cno":7576105559,"email":"","ename":"","eno":"","pphy":"GRANT, THOMAS R","ppno":7574465955,"pcpadd":"825 Fairfax Ave,Hofheimer Hall 1st Floor Suite 118","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"P0110940","pcpname":"PORTSMOUTH HEALTH DEPARTMENT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"1300 Parker Ave Apt B","madd2":"","madd3":"","mcity":"Portsmouth                    ","mstate":"VA","mzip":"23704-4422","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M20.40","M20.41","I70.223","L85.8","M77.40","J20.9","H25.13","M20.10"],"date":["2021-07-15","2021-03-11","2021-07-15","2021-07-15","2021-07-15","2021-05-18","2021-08-23","2021-07-15"],"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":[["","51991081403","AZELASTINE","SPR 0.001","","Select","Select",""],["","603533815","PREDNISONE","PAK 10MG","","Select","Select",""],["","378932132","WIXELA INHUB","AER 250\/50","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","527133850","DOXYCYC MONO","TAB 100MG","","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","378827052","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","527133850","DOXYCYC ","TAB 100MG","20","Select","Select",""],["","378932132","WIXELA ","AER 250\/50","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","90","Select","Select",""],["","33342032980","TRIAMCINOLON ","0.001","80","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","65862057490","MONTELUKAST","10MG","90","Select","Select",""],["","00378827052","ALBUTEROL","0.00083","75","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","69097094312","GABAPENTIN","300MG","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","33342032980","TRIAMCINOLON","0.001","80","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","90","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","00527133850","DOXYCYC","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":""}]}]}