{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARIANA   E MCDONALD","gend":1,"add":"561   FEATHERSTONE  COURT                                   ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23462-1920","dob":"1992-01-08","age":"","mstatus":"","insh":10085619,"cliId":"","pno":7579185655,"cno":7579185655,"email":"","ename":"","eno":"","pphy":"HAMBAZ, NASSER                                              ","ppno":"","pcpadd":"4876 Baxter Rd","pcpcity":"Virginia Beach                ","pcpstate":"VA","pcpzip":234624404,"pcpcounty":"","pcpid":"P0060179","pcpname":"FIRST CHOICE MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 103 APT 103                                             ","add3":"","madd1":"561   FEATHERSTONE  COURT                                   ","madd2":"APT 103 APT 103                                             ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23462-1920","pcpfaxno":7578537377,"pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O20.0","O99.89","O21.0","O99.611","O23.11","O99.281","O99.011","O99.331","D50.9","E87.6","R19.7","F17.200","Z3A.01","N30.01","O26.891","R10.2","O02.1","D64.9","O26.892","O46.92","R11.0","O99.012","Z3A.20","Z87.891","Z88.8","Z91.013","O20.8","F17.210","Z91.041","A59.00","Z11.3","N76.0","B00.89","J02.9","R07.9","J06.9","R05","R07.89","H60.91","K29.00","F41.0","D47.3","R11.2","F19.10","R45.0","Z91.09","D75.89","D64.89","N92.6","Z20.9","Z00.01","Z00.00","E05.90","M79.10","M79.605","M79.602","R20.0","R20.2","Z71.89","Z82.49","J30.2","M54.12","M54.2","R42","Z09","E04.2","E05.91","E05.20","E04.8","F41.8","N93.9","D25.1","N83.292","Z30.41","N83.202","R09.82","T78.49XA","J32.2","N93.0","R63.5","R63.2","R09.81","J34.89","J34.2","K64.8","K62.89","K62.5","R35.0","K64.4","Z87.19","Z98.890","K64.9","K61.0","Z88.3","S19.9XXA","M43.6","V89.2XXA","Y92.410","Z91.048","Z01.419","E66.9","R60.9","R50.9","R59.0","L53.9","J31.2","R87.610","R87.810","J30.89"],"date":["2019-01-16","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2020-12-14","2021-02-25","2019-01-16","2021-02-15","2019-01-27","2019-01-16","2019-01-16","2019-01-27","2019-03-07","2021-02-09","2019-01-27","2019-01-27","2019-01-27","2019-01-27","2019-01-27","2019-01-27","2021-06-17","2021-10-03","2019-01-27","2021-10-03","2021-06-17","2019-04-09","2021-07-22","2019-04-09","2021-02-12","2021-10-03","2019-09-23","2019-09-23","2019-09-23","2019-09-23","2020-06-27","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2021-08-26","2020-12-21","2021-02-09","2021-02-25","2021-02-09","2021-02-09","2021-02-09","2021-02-12","2021-02-15","2021-02-15","2021-02-15","2021-02-16","2021-02-16","2021-02-15","2021-02-15","2021-02-15","2021-02-16","2021-07-12","2021-02-16","2021-02-17","2021-08-30","2021-02-25","2021-02-25","2021-02-26","2021-02-26","2021-03-15","2021-03-15","2021-03-15","2021-11-16","2021-03-15","2021-06-11","2021-05-19","2021-10-21","2021-05-21","2021-05-21","2021-05-21","2021-06-11","2021-06-11","2021-06-11","2021-06-17","2021-06-19","2021-06-17","2021-06-17","2021-06-19","2021-06-17","2021-06-17","2021-06-17","2021-06-19","2021-06-19","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-10-03","2021-07-22","2021-07-22","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-10-03","2021-11-16","2021-11-16","2021-10-21"],"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":[["","13107008305","LORAZEPAM","0.5MG","30","Select","Select",""],["","00555902658","JUNEL","Jan-20","84","Select","Select",""],["","65162019050","NAPROXEN","500MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","20","Select","Select",""],["","45802086866","POLYETH","3350 NF","30","Select","Select",""],["","75834014130","LIDOCAINE","5%","60","Select","Select",""],["","49483060350","IBUPROFEN","600MG","30","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","57896010210","ACETAMINOPHE","325MG","30","Select","Select",""],["","50428027915","CVS","8.6MG","4","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","15","Select","Select",""],["","65862050320","AMOX\/K","875-125","19","Select","Select",""],["","49483008010","SENNA-TIME","8.6MG","56","Select","Select",""],["","67877022005","CEPHALEXIN","250MG","40","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00093117410","PENICILLN","500MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","42","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","10","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","28","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","49483034150","ACETAMINOPHN ","TAB 500MG","60","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","45","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","28","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","84","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","45802086866","POLYETH ","POW 3350 NF","30","Select","Select",""],["","75834014130","LIDOCAINE ","CRE 0.05","60","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","57896010210","ACETAMINOPHE ","TAB 325MG","30","Select","Select",""],["","50428027915","CVS ","TAB 8.6MG","4","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","15","Select","Select",""],["","49483008010","SENNA-TIME ","TAB 8.6MG","56","Select","Select",""],["","67877022005","CEPHALEXIN ","CAP 250MG","40","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","42","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","10","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","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","",""],["N\/A","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":""}]}]}