{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERRON WEBB UZZELL","gend":1,"add":"674 AQUA VISTA DRIVE","city":"NEWPORT NEWS","state":"VA","zip":"23607-6221","dob":"1961-04-03","age":"","mstatus":"","insh":10129627,"cliId":"","pno":7576965111,"cno":7576965111,"email":"","ename":"","eno":"","pphy":"WOLF, KEVIN PAUL","ppno":7575944431,"pcpadd":"12420 Warwick Blvd, Ste 4a","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236063053,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":7575994629,"add2":"APT E","add3":"","madd1":"674 AQUA VISTA DRIVE","madd2":"APT E","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23607-6221","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","L29.9","M72.2","M20.11","M20.12","K42.9","L30.9","L85.3","F33.2","L29.8","Z01.818","M20.41","I10","E66.3","D50.9","R63.4","M21.621","M77.41","M21.622","M77.42","F17.210","L29.0","L27.0","J06.9","F17.200","F45.8","R05","Z12.31","K43.2","K21.9","E03.9","F31.9","F20.9","M19.90","Z79.899","R09.81","R19.7","J98.01","I11.0","I50.9","Z12.11","M20.42","Z23","Z71.6","R10.2","M47.816","E78.5","M20.61","S86.899A","Z90.710","M19.072","M19.071","R35.0","N89.8","Z12.39","Z00.00","Z13.1","Z28.21","Z53.20","M79.671","M79.672","M77.51","M77.52","R10.84","K62.5","R10.9","M25.552","Z72.0","K43.9"],"date":["2021-02-10","2021-03-24","2019-02-25","2020-07-02","2020-08-24","2019-06-25","2021-03-16","2021-03-24","2021-05-09","2021-03-16","2020-06-30","2020-07-02","2021-03-24","2021-03-24","2019-06-26","2020-09-21","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-09-21","2020-12-15","2020-12-15","2019-04-12","2020-09-21","2019-06-25","2019-04-12","2019-05-14","2019-06-26","2020-08-24","2020-07-02","2019-06-26","2020-01-29","2019-06-26","2021-02-10","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2020-01-29","2020-08-24","2019-12-16","2019-12-16","2019-12-16","2019-12-16","2020-09-21","2020-07-02","2019-08-01","2020-01-29","2020-02-05","2020-02-05","2020-02-19","2020-02-19","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2019-03-28","2019-03-28","2019-03-28","2019-03-28","2019-05-17","2019-06-28"],"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":[["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","68645051054","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","68645051554","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","42","Select","Select",""],["","52565001159","TRIAMCINOLON ","LOT 0.001","60","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00603506021","PERPHENAZINE ","TAB 2MG","31","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","45802002146","BETAMETH ","LOT 0.0005","60","Select","Select",""],["","52380127204","CHLOR ","LIQ 0.04","118","Select","Select",""],["","00054001825","PREDNISONE ","TAB 20MG","14","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00378104901","DOXEPIN ","CAP 10MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","69452014320","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","68645056854","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00234057508","HIBICLENS ","LIQ 0.04","236","Select","Select",""],["","00316022975","SARNA ","LOT ","222","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","40","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","40","Select","Select",""],["","45802049078","NAPROXEN ","TAB 220MG","60","Select","Select",""],["","00904645780","DOK ","CAP 100MG","20","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","00527128201","DICYCLOMINE ","TAB 20MG","30","Select","Select",""],["","16714079904","CETIRIZINE ","10MG","30","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","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":""}]}]}