{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FELTON MITCHELL","gend":0,"add":"5708   NORTHAMPTON BOULEVARD                                ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23455-3704","dob":"1959-03-15","age":"","mstatus":"","insh":10047590,"cliId":"","pno":7573597103,"cno":7573597103,"email":"","ename":"","eno":"","pphy":"SARINO, NELSON C                                            ","ppno":"","pcpadd":"1147 Independence Blvd","pcpcity":"Virginia Beach                ","pcpstate":"VA","pcpzip":234555545,"pcpcounty":"","pcpid":"P0060297","pcpname":"FAMILY MEDICAL PRACTITIONERS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 136                                                     ","add3":"","madd1":"5708   NORTHAMPTON BOULEVARD                                ","madd2":"APT 136                                                     ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23455-3704","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M22.2X1","M17.11","Z68.29","M25.511","S49.91XA","S46.211A","M79.18","X50.0XXA","Y93.89","M19.011","M25.711","I10","Z86.69","F17.210","Z79.899","R73.02","E78.2","Z12.5","M25.561","M79.604","R26.89","R53.83"],"date":["2019-04-04","2021-05-10","2019-04-04","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2021-06-03","2019-05-21","2019-05-21","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2021-06-03","2020-11-30","2021-06-03","2021-06-03"],"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":[["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","68180051902","LISINOP\/HCTZ","20-12.5","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","TAB 20-12.5","30","Select","Select",""],["","65162062711","TRAMADOL ","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","",""],["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":""}]}]}