{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAYKERA NORFLEET","gend":1,"add":"410 WELLONS STREET","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1997-12-29","age":"","mstatus":"","insh":10100040,"cliId":"","pno":7573625796,"cno":7573625796,"email":"","ename":"","eno":"","pphy":"BROOKS-WILLIAMS, MALINDA","ppno":8047800840,"pcpadd":"4730 N Southside Plaza St, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 404","add3":"","madd1":"410 WELLONS STREET","madd2":"APT 404","madd3":"","mcity":"SUFFOLK","mstate":"VA","mzip":"23434-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.213","E66.9","Z3A.33","Z3A.34","Z68.41","Z3A.35","Z3A.36","Z3A.37","O42.92","O99.824","O62.1","O69.81X0","Z3A.39","Z37.0","Z87.891","M54.5","Z11.3","Z93.1","Z01.419","E66.01","R79.89","L73.2","N89.8","Z34.83","Z3A.38","R10.9","J03.90","O99.210","Z76.89","G56.03","F32.9","M54.9","G89.29","R53.83","N39.0","J02.9"],"date":["2019-02-26","2019-02-26","2019-01-22","2019-01-29","2020-06-12","2019-02-05","2019-02-12","2019-02-19","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2020-06-12","2020-11-11","2019-03-06","2020-11-11","2020-11-11","2020-11-11","2021-04-21","2020-01-27","2019-02-12","2019-02-26","2020-01-21","2021-01-31","2019-02-12","2020-06-12","2020-06-12","2020-06-12","2020-06-30","2020-06-12","2020-06-12","2019-04-09","2019-04-09"],"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":[["","00472037915","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","68180031909","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","60258019601","PRENATAL ","TAB ","30","Select","Select",""],["","69238110305","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","8","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00363106108","ANTISEPTIC ","SOL SKIN CLN","237","Select","Select",""],["","68180087313","WYMZYA ","CHW 0.4MG-35","28","Select","Select",""],["","53489012002","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","28","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","20","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68462018117","CLOTRIMAZOLE ","CRE 0.01","15","Select","Select",""],["","00115202410","NITROFUR ","100MG","10","Select","Select",""],["","00054350049","LIDOCAINE ","2% VISC","100","Select","Select",""],["","00093031401","KETOROLAC ","10MG","10","Select","Select",""],["","00591544305","PREDNISONE ","20MG","3","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":""}]}]}