{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   A DEMARY","gend":1,"add":"1816 COLUMBIA STREET","city":"PORTSMOUTH","state":"VA","zip":"23704-0000","dob":"1957-07-17","age":"","mstatus":"","insh":10101395,"cliId":"","pno":7575377071,"cno":7576393854,"email":"","ename":"","eno":"","pphy":"ROSENBERG, DAVID","ppno":7573936363,"pcpadd":"664 LINCOLN STREET, ","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":237044818,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":7576393854,"add2":"HOMELESS","add3":"","madd1":"1816 COLUMBIA STREET","madd2":"c\/o Robert Smyers","madd3":"","mcity":"PORTSMOUTH","mstate":"VA","mzip":"23704-0000","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D64.9","E87.6","C22.9","B18.2","K74.60","J90","R06.02","R07.9","R06.00","B19.20","Z85.05","F17.210","R77.2","Z23","R68.89","Z01.89","K80.20","R18.8","K92.2","D62","D68.9","K92.0","D50.0","K22.10","K44.9","M95.0","J34.89","M79.604","M79.605","C22.0","Z87.09","S22.31XS","Z68.25","M25.18","Z01.812","K22.719","R10.9","K25.4","D50.9","R00.0","I85.10","D68.4","E43","G89.29","K76.6","Z87.891","Z79.899","Z68.26","K25.9","M62.838","J98.11","K22.70","I85.01","I85.11","S29.011D","X58.XXXD","K76.9","L90.5","S09.93XS","Z98.890","J32.0","D69.6","Z87.11","Z92.3","T39.395A","J32.9","K92.1","D72.829","K74.69","K21.9","Z87.19","K20.9","R04.2","K22.11","F41.9","R07.89","N17.9","R07.81","D72.819","D69.9","C22.8","Z88.5","R04.0","J34.0","R42","R11.0","Z86.19","R91.8","K29.30","K20.8","R00.1","I49.1","S22.31XA","I10","K27.9","K31.89","Z48.817"],"date":["2020-10-14","2020-02-14","2019-01-31","2020-07-27","2020-12-15","2020-04-23","2019-07-30","2019-07-14","2019-07-30","2020-10-14","2020-07-27","2019-07-30","2019-04-02","2019-09-24","2021-01-19","2019-07-30","2020-04-23","2020-02-13","2020-09-08","2020-09-09","2020-05-19","2020-09-08","2020-07-28","2020-09-09","2020-09-09","2020-11-09","2020-12-15","2019-01-31","2019-01-31","2020-10-14","2019-08-14","2019-08-14","2019-08-14","2019-10-28","2019-10-28","2020-05-21","2020-09-08","2020-05-19","2020-09-08","2020-05-19","2020-05-21","2020-05-19","2020-05-19","2020-05-19","2020-09-08","2020-07-27","2020-09-08","2019-02-21","2020-02-12","2020-02-14","2020-04-23","2020-07-27","2020-07-28","2020-07-27","2019-08-04","2019-08-04","2019-09-24","2019-11-21","2019-11-06","2019-11-06","2019-11-06","2020-02-12","2020-02-12","2020-07-27","2020-02-12","2020-04-23","2020-05-19","2020-05-19","2020-07-27","2020-07-27","2020-07-27","2020-09-08","2020-09-08","2020-09-09","2020-12-15","2019-07-14","2019-07-14","2019-08-04","2019-07-30","2019-07-30","2019-08-04","2019-08-04","2019-11-06","2019-11-14","2020-02-11","2020-09-08","2019-07-14","2019-07-14","2020-05-21","2020-07-27","2020-12-15","2019-07-30","2019-08-04","2020-09-08","2020-09-08","2020-09-08","2019-11-21"],"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":[["","61958220101","EPCLUSA ","TAB 400-100","28","Select","Select",""],["","00378024301","SPIRONOLACT ","TAB 50MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","80","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","60","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","69097086707","NADOLOL ","TAB 20MG","30","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","57664051083","MIRTAZAPINE ","TAB 7.5MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","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":""}]}]}