{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH BARNES","gend":0,"add":"211 W 27TH STREET                                           ","city":"NORFOLK                       ","state":"VA","zip":"23517-1354","dob":"1961-02-12","age":"","mstatus":"","insh":10046956,"cliId":"","pno":7572821795,"cno":7572821795,"email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR                                          ","ppno":"","pcpadd":"3415 Granby St,2116 W Laburnum Ave Ste 100","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235041421,"pcpcounty":"","pcpid":"P9058932","pcpname":"PARK PLACE MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"APT. 1                                                      ","add3":"","madd1":"211 W 27TH STREET                                           ","madd2":"APT. 1                                                      ","madd3":"","mcity":"NORFOLK                       ","mstate":"VA","mzip":"23517-1354","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10","J01.10","F14.10","J00","Z20.2","Z72.51","J02.9","J32.0","R05","Z68.33","J01.00","J01.90"],"date":["2021-06-17","2020-11-30","2019-02-05","2019-02-05","2019-02-23","2019-02-23","2019-02-23","2019-10-17","2019-10-30","2019-10-30","2020-02-10","2020-11-30","2021-06-17"],"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":[["","00143928501","AMOXICILLIN","875MG","20","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","210","Select","Select",""],["","68645058459","METFORMIN","1000MG","60","Select","Select",""],["","29300013501","CLONIDINE","0.1MG","34","Select","Select",""],["","68645055754","LISINOP\/HCTZ","20-12.5","30","Select","Select",""],["","00093505998","ATORVASTATIN","20MG","90","Select","Select",""],["","16571030216","GUAIFENESIN","100-10\/5","210","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0.5","Select","Select",""],["","00143928501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","210","Select","Select",""],["","68645058459","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","29300013501","CLONIDINE ","TAB 0.1MG","34","Select","Select",""],["","68645055754","LISINOP\/HCTZ ","TAB 20-12.5","30","Select","Select",""],["","00093505998","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","16571030216","GUAIFENESIN ","SYP 100-10\/5","210","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0.5","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","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":""}]}]}