{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONY MABRY","gend":0,"add":"605 SEVENTH STREET","city":"PORTSMOUTH","state":"VA","zip":"23704-5819","dob":"1967-02-10","age":"","mstatus":"","insh":10026750,"cliId":"","pno":7577386037,"cno":"               ","email":"","ename":"","eno":"","pphy":"WELLS, JANELL","ppno":7573636363,"pcpadd":"9581 Shore Dr, ","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235181711,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"APARTMENT B","add3":"","madd1":"605 SEVENTH STREET","madd2":"APARTMENT B","madd3":"","mcity":"PORTSMOUTH","mstate":"VA","mzip":"23704-5819","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","I13.2","N18.6","Z99.2","E11.22","I50.9","I25.10","E78.5","I34.0","E11.40","E11.319","G47.30","Z79.4","Z79.82","I12.0","D63.1","I27.20","Z79.899","R65.10","J98.4","L97.529","M79.672","E11.621","L97.509","L97.429","M86.9","E83.39","M00.80","R47.89","M86.672","N25.81","M00.9","Z91.048","Z88.8","K21.9","L97.522","E10.42","L89.622","E11.9","I42.9","E11.649","I10","Z48.89","A49.02","Z86.718","Z86.73","I73.9","D62","Z91.19","E11.628","L08.9","I13.11","I74.2","Z48.812","M86.172","L89.529","M79.644","Z79.890","Z88.2","B99.9","T87.44","T87.89","Y83.5","Y92.239","G93.41","I50.22","T87.81","E11.65","I25.5","E03.9","E11.51","D69.6","I50.20","I48.91","S98.312A","F43.21","R45.1","R55","I50.21","M79.609","T14.8XXD","L03.116","T81.89XA","M79.605","R07.9","R06.02","T87.40","R78.81","N18.5","Z91.09","R10.9","R53.83","R77.8","R10.84","Z86.79","E87.70","Z45.2","J90","J81.1","I46.9","J96.01","J18.9","R93.89","R91.8","R07.89","R06.89","I31.9","A41.9","G93.40","I16.0","N18.9","R69","Z89.519","R52","E87.5","D72.819","R53.81","R07.81","I15.9","Z91.14","M00.869","R41.82","L97.525","G89.18","E11.69","N40.0","M86.372","E11.8","E11.42","M86.171","R60.0","D64.9","E11.52","I50.43","T81.42XA","I70.262","L97.821","L97.824","M86.679","I42.8","I42.0","L03.032","M79.89","Z01.818","R60.9","R06.00","I20.8","S81.002D","S81.802D","S91.002D","K92.2","R11.10","S91.302A","B95.62","R41.0","M79.661","I31.3","I08.1","M79.662","R50.9","W04.XXXA","Y92.231","E66.9","R40.0","G47.33","Z89.512","Z96.1","R06.9","R05","Z86.74","Z86.19","J15.6","I07.1","R60.1","M79.601","D61.818","Z66","Z51.5","D63.8","J69.0","B96.20","I96","I95.9","E87.2","E83.59","J96.92","R65.21","J96.10","Z99.81","I50.23","Z86.2","Z68.33","R47.01","Z47.81","L97.523","I50.42","I48.0","Z89.422","Z79.2","T81.31XD","Z03.89","M62.262","E11.21","G89.29","R19.5","S29.9XXA","M54.2","R51","M79.652","M54.5","T81.31XA","Z91.15","N25.89","L97.421","I13.0","L97.519","M86.8X7","Z82.3","Z83.3","T81.89XD","Z53.20","N32.89","R18.8","R00.0","I21.4","M25.50","Z87.11","J15.5","Y84.8","G92","J96.02","I63.9","I46.8","A41.51","M86.60","X58.XXXA","T81.41XA","T81.44XA","G93.1","D68.9","I12.9","E11.610","B95.2","R10.30","R07.82","R21","Z16.21","R79.1","Z79.1","M79.606","S89.90XA","R10.13","R22.0","R57.9","N19","R07.2","Z86.39","I50.32","Z82.49","Z80.0","E11.641","L97.524","E13.621","B95.61","I36.1","I51.7","I51.9","I27.29","L89.151","Z51.89","Z74.09","E08.628","C64.9","I70.244","E66.01","Z68.32","Z89.432","Z95.828","T87.54","E87.1","Z28.21","Z79.891","Z53.21","R50.81","X58.XXXD","Z98.890","K31.84","E27.9","Y95","F41.9","E87.79","T14.8XXA","I70.268","Z71.89","N30.90","R09.02","M79.631","L03.90","B96.4","L29.9","L03.115","I70.202","Z87.39","M25.572","G62.9","L28.1","L73.9","L97.919","G04.00","T81.49XA","A41.02","E11.43","K22.4","S88.112A","E10.9","R11.2","N50.89","M25.521","N17.9","I63.233","R40.4","I69.398","K59.00","K64.9","J98.11","G89.28","R53.1","Z46.59","Z46.82","S41.101A","L97.528","L97.505","F45.8","Z76.5","E83.51","L97.423","L02.612","L02.416","I70.0","I74.3","I99.8","L97.226","V48.5XXA","I50.33","L02.91","Y92.9","L02.214","S81.802A","W19.XXXA","Z90.49","Z48.00","R79.89","R94.5","R42"],"date":["2020-02-29","2020-02-28","2020-02-29","2020-02-25","2020-02-29","2020-02-24","2020-02-24","2020-02-24","2020-01-13","2020-02-14","2020-01-23","2019-11-28","2020-01-01","2020-01-20","2020-02-25","2020-02-18","2020-01-23","2020-02-24","2019-12-12","2019-03-13","2019-08-27","2019-08-07","2019-09-20","2019-05-16","2019-05-20","2020-01-30","2020-02-18","2019-03-14","2019-03-19","2020-01-30","2020-02-25","2019-03-22","2020-01-23","2020-01-02","2020-02-24","2019-07-23","2019-04-10","2019-07-18","2019-11-05","2019-11-28","2019-04-18","2020-01-09","2019-08-08","2019-05-06","2019-05-10","2020-02-24","2019-12-11","2019-06-11","2020-02-14","2019-10-04","2020-02-14","2019-06-05","2019-06-12","2019-06-12","2019-09-04","2019-06-25","2019-06-24","2019-12-23","2020-01-23","2019-08-01","2020-02-28","2019-12-24","2020-01-24","2019-08-02","2019-12-31","2020-01-30","2019-11-05","2019-08-06","2019-08-05","2020-02-14","2020-02-28","2019-11-08","2019-08-05","2019-08-07","2019-08-23","2020-02-03","2019-09-03","2020-02-28","2019-10-25","2019-10-30","2019-10-30","2019-11-02","2019-12-11","2020-01-01","2020-02-28","2020-02-14","2019-11-08","2019-11-08","2019-12-30","2020-01-13","2020-02-18","2020-02-24","2019-12-24","2019-12-24","2019-12-24","2020-02-26","2020-01-26","2020-02-29","2020-02-26","2020-02-29","2020-02-14","2020-02-19","2020-01-28","2020-02-29","2020-02-11","2020-02-07","2020-02-07","2020-02-28","2020-02-29","2020-02-21","2020-02-27","2020-02-27","2020-02-27","2020-02-03","2020-02-14","2019-01-22","2020-02-03","2019-01-18","2019-01-25","2019-12-04","2019-03-08","2019-03-19","2019-05-16","2019-04-06","2019-09-03","2020-01-10","2019-04-19","2019-04-19","2019-10-21","2019-04-17","2020-02-14","2019-08-28","2020-02-14","2020-01-24","2019-08-13","2019-09-20","2019-05-16","2019-05-16","2019-05-16","2019-12-30","2019-05-16","2019-06-05","2019-12-05","2019-11-07","2020-02-24","2020-02-03","2019-08-14","2019-12-11","2019-12-11","2019-12-11","2019-08-29","2019-08-27","2019-08-27","2019-09-04","2020-02-01","2019-10-13","2020-01-31","2020-01-25","2019-11-19","2019-11-05","2019-11-03","2019-11-03","2019-11-03","2019-11-22","2020-01-24","2020-02-24","2019-11-22","2019-11-28","2020-01-23","2020-02-04","2020-01-29","2020-01-29","2020-01-31","2020-02-06","2020-02-06","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-25","2020-02-29","2020-02-29","2019-01-18","2019-12-31","2019-11-01","2019-01-23","2019-01-23","2019-03-26","2019-07-20","2019-05-11","2020-01-24","2019-07-20","2019-12-02","2019-07-20","2019-05-09","2019-06-19","2019-05-31","2019-08-29","2020-02-24","2019-08-28","2019-10-22","2019-10-22","2019-12-11","2019-10-22","2019-10-22","2019-11-08","2019-11-05","2019-01-21","2019-02-20","2019-02-20","2019-03-12","2019-03-13","2019-03-13","2019-03-13","2019-12-10","2019-12-10","2019-12-24","2019-12-24","2019-12-24","2019-12-31","2020-01-01","2020-01-01","2020-02-28","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-02-19","2020-02-27","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2019-05-19","2019-07-20","2019-07-20","2019-07-11","2019-08-17","2019-08-17","2019-09-18","2019-09-19","2019-10-11","2019-10-22","2019-10-22","2019-12-12","2020-01-27","2020-02-29","2020-02-29","2019-01-09","2019-01-09","2019-01-09","2019-01-09","2019-01-09","2019-03-08","2019-03-08","2019-03-08","2019-03-08","2019-03-20","2020-01-25","2019-03-20","2019-03-20","2019-04-07","2019-04-07","2019-04-27","2019-05-17","2019-05-22","2019-05-31","2019-08-02","2019-08-02","2020-01-02","2019-08-23","2019-09-03","2019-09-03","2019-09-03","2019-10-08","2019-11-01","2019-11-03","2019-12-11","2019-12-11","2019-12-30","2019-12-30","2019-12-30","2020-02-04","2020-02-14","2020-02-14","2020-02-17","2020-02-19","2020-02-24","2020-02-24","2020-02-24","2019-11-02","2019-03-15","2019-03-22","2019-09-20","2019-04-17","2019-05-20","2019-07-15","2019-07-15","2019-08-17","2019-08-17","2019-09-20","2019-09-24","2019-11-08","2019-11-08","2019-12-24","2019-12-25","2020-01-09","2020-01-09","2020-01-31","2020-01-23","2020-02-26","2019-01-23","2019-03-19","2019-09-03","2019-08-08","2019-08-27","2019-08-27","2019-09-03","2019-11-19","2020-01-02","2020-01-26","2020-02-29","2020-02-06","2019-03-07","2019-03-10","2019-03-19","2019-03-19","2019-03-19","2019-08-13","2019-08-13","2019-08-13","2019-09-06","2019-09-10","2019-09-10","2019-09-20","2019-10-22","2019-10-23","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2019-12-10","2019-12-10","2019-12-11","2020-01-01","2019-12-31","2020-02-14"],"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":[]},{"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":[["","49348075707","SM ","CHW 81MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","21","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","00536124701","SENEXON-S ","TAB 8.6-50MG","28","Select","Select",""],["","55111078927","SEVELAMER ","TAB 800MG","90","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","12","Select","Select",""],["","00406012401","HYDROCO\/APAP ","TAB 7.5-325","21","Select","Select",""],["","13668010410","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","13811052501","TRIPHROCAPS ","CAP ","30","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","50111039701","HYDRALAZINE ","TAB 100MG","60","Select","Select",""],["","00316022975","SARNA ","LOT ","222","Select","Select",""],["","00904052380","VITAMIN ","TAB 500MG","26","Select","Select",""],["","37864099101","ZINC ","CAP 220MG","9","Select","Select",""],["","39328006325","HYSEPT ","SOL 0.0025","473","Select","Select",""],["","65862060330","MOXIFLOXACIN ","TAB 400MG","5","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","56","Select","Select",""],["","63304061650","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","00378180377","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","65862014305","CARVEDILOL ","TAB 6.25MG","60","Select","Select",""],["","65862020290","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","3","Select","Select",""],["","09958003471","MEDIHONEY ","GEL WOUND","44","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","68645051354","NIFEDIPINE ","TAB 60MG ER","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","16714008211","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","14","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}