{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   M RISPER","gend":1,"add":"2562 REAGAN AVENUE","city":"VIRGINIA BEACH","state":"VA","zip":"23454-3267","dob":"1962-03-19","age":"","mstatus":"","insh":10123882,"cliId":"","pno":7578084879,"cno":7578084879,"email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF LEWIS","ppno":5404334913,"pcpadd":"339 NEBO SCHOOL RD, ","pcpcity":"NEBO","pcpstate":"NC","pcpzip":287616848,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2562 REAGAN AVENUE","madd2":"                                                            ","madd3":"","mcity":"VIRGINIA BEACH","mstate":"VA","mzip":"23454-3267","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","I49.2","I49.01","R79.89","Z95.2","I47.1","I50.33","I42.9","Z95.810","N19","I36.1","R50.9","R60.0","A49.1","T82.198D","R78.81","R55","N17.9","I47.2","I48.0","B18.2","F14.10","I95.9","I44.30","F10.10","I42.8","I27.20","Z95.3","Z91.19","Z79.01","I50.9","R07.9","G47.33","J40","I50.40","E80.6","K82.8","R18.8","I50.41","J20.8","I38","I27.21","T82.857A","I50.22","S30.1XXA","N17.0","N18.3","I95.89","E83.42","R33.9","S30.1XXD","Z01.810","I05.9","Y83.8","Y73.8","I82.C21","Q21.1","I34.0","D69.6","Z20.828","E04.1","Z79.02","Z79.82","Z79.899","I07.1","I51.7","Z45.02","Z95.4","I44.2","A40.8","A41.9","J18.9","I50.23","E87.2","I82.629","I82.C11","I82.619","R65.20","I05.1","I48.91","T82.198A","F41.0","R06.02","R91.1","J84.10","Z87.891","M79.81","N13.30","I08.1","I42.0","I11.0","Z82.49","Z88.8","Z95.811","R05","Z20.822","J20.9","R91.8","E87.6","F17.210","I27.29","I35.9","I33.0","J39.0","K12.2","I35.1","B95.5","I50.20","L29.9","R94.5","A40.9","I82.621","I49.5","Z01.818","I50.32","Z86.718","R30.0","Z12.31","I49.9","I08.3","R60.9","I50.42","G89.4","J39.2","I95.0","F19.20","R22.43","Z87.09","Z86.79","I34.2","I05.2","Z00.6","I05.0","I49.8","Z00.00","Z12.39","Z12.11","Z12.4","J06.9","H66.91","L08.9","K04.7","J81.1","T82.198S","D65","R19.03","R10.31","Z01.419","M79.601","R06.2","Z95.0","I48.19","E66.9","I35.0","J90","Z98.890","D62","B19.20","N18.30","D63.1","R53.81","D50.9","N18.9","I50.43","I13.0","G47.30","Y83.1","K66.1","E87.1","G90.50","I50.82","T82.09XA","N28.9","S30.1XXS","Z13.820"],"date":["2021-01-19","2019-10-16","2020-12-29","2019-10-16","2021-05-11","2020-12-29","2020-05-06","2019-12-12","2021-05-13","2019-10-17","2021-05-11","2019-10-19","2020-03-09","2019-10-28","2019-10-23","2019-11-11","2019-12-12","2020-03-19","2021-02-11","2021-05-11","2020-03-02","2021-05-11","2020-04-22","2019-12-12","2019-12-15","2020-09-29","2021-05-11","2021-05-11","2020-01-15","2021-05-11","2020-03-19","2020-01-15","2020-02-28","2020-03-02","2020-03-13","2020-03-09","2020-03-09","2020-03-10","2020-03-13","2020-03-13","2020-03-13","2020-04-24","2020-05-08","2020-12-29","2020-05-07","2020-03-20","2020-05-06","2021-05-11","2020-03-20","2020-03-20","2020-03-20","2020-04-27","2020-04-27","2020-05-06","2020-05-06","2021-05-11","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-12-29","2020-11-12","2020-11-12","2020-12-29","2020-12-29","2021-05-13","2019-10-28","2019-10-23","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2019-10-19","2019-10-15","2019-10-28","2019-10-17","2020-01-13","2019-10-25","2019-12-17","2020-03-10","2020-05-01","2020-01-15","2020-01-15","2020-03-15","2020-03-15","2020-06-04","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-04-23","2021-04-23","2020-03-02","2020-01-15","2019-07-27","2019-10-19","2019-10-19","2019-07-29","2019-10-23","2019-10-23","2019-10-23","2020-11-24","2019-11-11","2020-02-06","2020-01-24","2019-10-15","2019-10-28","2019-10-28","2019-10-22","2020-05-04","2020-04-24","2019-12-12","2020-03-24","2021-04-30","2019-07-29","2021-05-11","2019-10-16","2019-10-19","2019-10-19","2019-10-23","2019-10-28","2019-10-28","2020-01-15","2020-01-15","2020-11-12","2020-05-08","2020-05-06","2020-05-06","2020-06-01","2020-12-21","2021-04-09","2021-03-29","2021-03-29","2021-03-29","2019-05-28","2019-05-28","2019-10-21","2019-10-21","2020-05-06","2019-10-28","2019-10-28","2020-03-15","2020-03-15","2021-04-29","2019-09-13","2019-09-13","2020-01-13","2020-04-24","2020-04-24","2020-11-12","2020-05-06","2020-05-06","2020-05-13","2021-05-11","2021-05-11","2021-05-11","2019-05-28","2019-05-28","2020-03-19","2020-03-02","2019-10-28","2019-12-31","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-06","2020-03-06","2020-03-19","2020-03-19","2021-04-29"],"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":[["","00904052360","VITAMIN ","TAB 500MG","30","Select","Select",""],["","00245010810","FERROUS ","TAB 325MG EC","60","Select","Select",""],["","49035035934","EQ ","SYP CGH\/CHST","100","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","60","Select","Select",""],["","60258017101","MAG ","TAB 400MG","90","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","120","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","180","Select","Select",""],["","49035056314","ASPIRIN ","TAB 81MG EC","90","Select","Select",""],["","65862014305","CARVEDILOL ","TAB 6.25MG","60","Select","Select",""],["","69452014430","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","00904549280","THERA-M ","TAB ","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","14","Select","Select",""],["","00245021311","MIDODRINE ","TAB 10MG","90","Select","Select",""],["","57896070310","IRON ","TAB 325MG","60","Select","Select",""],["","00527221537","METOLAZONE ","TAB 2.5MG","12","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","00713028031","BACITRACIN ","OIN 500\/GM","28.4","Select","Select",""],["","68382022705","AMIODARONE ","TAB 200MG","30","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","6","Select","Select",""],["","00074262528","MAVYRET ","TAB 100-40MG","84","Select","Select",""],["","00093874001","MEXILETINE ","CAP 200MG","90","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","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","",""],["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":""}]}]}