{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRISSIE   A TREVINO","gend":1,"add":"510 BELEM DRIVE","city":"CHESAPEAKE","state":"VA","zip":"23322-8037","dob":"1975-12-04","age":"","mstatus":"","insh":10129674,"cliId":"","pno":7577567089,"cno":7577567089,"email":"","ename":"","eno":"","pphy":"SKINNER, ALISON C","ppno":7577381600,"pcpadd":"3253 Taylor Rd, Ste 200","pcpcity":"Chesapeake","pcpstate":"VA","pcpzip":233212452,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":7573898162,"add2":"                                                            ","add3":"","madd1":"510 BELEM DRIVE","madd2":"                                                            ","madd3":"","mcity":"CHESAPEAKE","mstate":"VA","mzip":"23322-8037","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","Z68.28","F90.0","B19.20","Z71.3","R73.9","D25.9","N92.0","M53.87","M99.03","M62.830","M99.05","S73.032A","R74.8","K82.4","K76.0","R76.8","F11.229","F11.23","F14.229","F33.2","F11.14","F14.23","F11.188","Z87.898","Z68.27","Z01.419","Z12.31","Z11.3","M54.9","F11.20","F14.288","F14.280","F31.63","M79.7","G43.909","Z62.810","Z62.811","F14.24","Z91.5","K74.0","Z12.4","Z32.02","F15.23","F32.9","F13.10","F43.8","F90.2","F31.32","N64.89","R92.8","R63.5","B17.10","L30.8"],"date":["2019-05-15","2019-06-13","2019-05-28","2019-11-11","2019-06-13","2020-06-05","2021-04-19","2021-04-19","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2019-06-25","2019-07-30","2019-07-30","2019-02-04","2019-04-27","2019-04-28","2019-04-24","2019-04-24","2019-04-28","2019-04-28","2019-04-24","2019-05-15","2019-08-05","2021-03-31","2021-03-31","2019-08-05","2020-08-04","2019-04-23","2019-04-23","2019-04-23","2019-04-23","2020-04-16","2019-04-23","2019-04-23","2019-04-23","2019-04-23","2019-04-23","2019-07-22","2021-03-31","2021-04-19","2019-04-28","2019-04-27","2019-04-25","2019-04-28","2019-10-22","2019-10-22","2020-04-06","2020-04-06","2020-06-22","2019-04-23","2020-04-16"],"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":[["","68645056054","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","59762500701","MISOPROSTOL ","TAB 100MCG","30","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","62332048515","DESONIDE ","OIN 0.0005","15","Select","Select",""],["","00832003800","OXYBUTYNIN ","TAB 5MG","60","Select","Select",""],["","55111029398","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","69097084607","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","00904674860","BISACODYL ","5MG EC","4","Select","Select",""],["","00904678744","MAG ","LEMON","296","Select","Select",""],["","30142030602","GENTLELAX ","","238","Select","Select",""],["","55111064505","OMEPRAZOLE ","40MG","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","",""],["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":""}]}]}