{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMARA F FREEMAN","gend":1,"add":"1020 THRIVE PLACE APT 202  ","city":"CHESAPEAKE  ","state":"VA","zip":"23323-9998","dob":"1980-10-01","age":"","mstatus":"","insh":11017751,"cliId":"4UV5QX2UV51","pno":7578364891,"cno":7578003692,"email":"","ename":"","eno":"","pphy":"KAPUR, ANAND","ppno":7576735890,"pcpadd":"5818 Harbour View Blvd Ste 250","pcpcity":"Suffolk  ","pcpstate":"VA","pcpzip":234353317,"pcpcounty":"","pcpid":"P0119763","pcpname":"BON SECOURS GRASSFIELD MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APT 202","add3":"","madd1":"1020 THRIVE PLACE APT 202  ","madd2":"APT 202","madd3":"","mcity":"CHESAPEAKE  ","mstate":"VA","mzip":"23323-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.571","S82.831A","S82.891A","W18.49XA","S93.401A","F17.200","W19.XXXA","S82.831D","M25.511","M54.42","G89.29","R11.2","Z79.899","R10.9","R11.10","S82.61XA","R94.31","Z01.818","Z20.822","Z01.810","R60.0","M51.34","F17.210","M19.90","G89.18","X58.XXXA","Z79.1","S82.891D","Z98.890","S82.891S","Z00.00","F12.90","Z68.21","Z71.89","R23.8","Z87.81","R63.4","F43.9","G25.81","H02.823","H02.826","F51.04","M75.101","M12.811"],"date":["2021-06-08","2021-05-09","2021-05-27","2021-05-09","2021-05-09","2021-05-17","2021-05-09","2021-05-13","2021-10-26","2021-10-26","2021-11-09","2021-05-17","2021-05-27","2021-05-17","2021-05-17","2021-05-27","2021-05-21","2021-05-25","2021-05-21","2021-05-21","2021-05-25","2021-05-25","2021-10-26","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-06-25","2021-07-07","2021-06-09","2021-07-07","2021-09-29","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-08-09","2021-08-09","2021-10-26","2021-08-09","2021-08-09","2021-09-29","2021-11-09","2021-11-09"],"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":[]},{"a":[]}]},{"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":[["","65162018910","NAPROXEN ","TAB 375MG","14","Select","Select",""],["","31722094901","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","57664037713","TRAMADOL ","TAB 50MG","60","Select","Select",""],["","406012405","HYDROCO\/APAP ","7.5-325","42","Select","Select",""],["","93220305","METOCLOPRAM ","10MG","12","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","20","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","14","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","45802004935","TRIAMCINOLON ","0.005","30","Select","Select",""],["","65862001905","CEPHALEXIN ","500MG","28","Select","Select",""],["","51991074710","DULOXETINE ","30MG","90","Select","Select",""],["","57664037713","TRAMADOL","50MG","60","Select","Select",""],["","10702018901","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","45802004935","TRIAMCINOLON","0.005","30","Select","Select",""],["","16714033002","GABAPENTIN","600MG","90","Select","Select",""],["","65162018910","NAPROXEN","375MG","14","Select","Select",""],["","31722094901","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","00093220305","METOCLOPRAM","10MG","12","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","20","Select","Select",""],["","51991074710","DULOXETINE","30MG","90","Select","Select",""],["","65862001905","CEPHALEXIN","500MG","28","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","30","Select","Select",""],["","16714043901","NITROFURANTN","100MG","14","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","16714033002","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","30","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":""}]}]}