{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELBY STRICKLAND GARCIA","gend":1,"add":"35 DEERFIELD BOULEVARD","city":"HAMPTON","state":"VA","zip":"23666-1739","dob":"1964-02-13","age":"","mstatus":"","insh":10158695,"cliId":"","pno":7573271280,"cno":7579777390,"email":"","ename":"","eno":"","pphy":"MILLER, JACOB","ppno":7572782240,"pcpadd":"150 Kingsley Ln Ste 4000, ","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235054602,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":7579448847,"add2":"                                                            ","add3":"","madd1":"35 DEERFIELD BOULEVARD","madd2":"                                                            ","madd3":"","mcity":"HAMPTON","mstate":"VA","mzip":"23666-1739","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S91.311A","W25.XXXA","Y93.01","Y92.009","I10","Z90.49","F17.200","F32.9","F43.10","Z79.899","R68.89","Z00.00","R05","R53.83","J45.909","E78.5","R73.09","E66.01","Z28.21","Z12.11","M25.561","F31.64","N39.0","R11.2","B96.29","Z16.11","Z68.41","F17.210","Z71.3","F33.3","R73.03","F33.1","M17.0","E78.2","J45.40","Z13.220","Z13.0","Z12.39","Z13.29","K62.1","F60.3","F31.30","Z01.818","Z11.59","M25.562","M25.462","M25.661","R52","R06.02","J10.1","R11.10","R06.00","R07.89","Z03.89","M17.12","M17.11","J44.9","Z13.1","M25.862","F25.9","Z12.31","R10.9","Z20.828","S61.051A","S16.1XXA","S60.811A","R03.0","T14.8XXA","M17.10","M79.606","R11.0","S61.031A","W54.0XXA","X50.1XXA","S39.012A","M85.80"],"date":["2019-07-11","2019-07-11","2019-07-11","2019-07-11","2021-03-07","2019-07-11","2021-03-07","2019-11-04","2020-02-10","2021-03-07","2020-06-23","2020-06-08","2020-05-31","2019-10-23","2019-11-20","2021-03-07","2019-11-20","2020-05-31","2019-10-23","2020-06-23","2021-03-07","2020-01-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2021-05-10","2020-06-08","2020-07-10","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-23","2020-07-10","2020-10-22","2020-06-19","2020-06-19","2021-02-24","2021-03-07","2021-02-24","2021-03-07","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2021-01-27","2021-03-07","2021-03-07","2019-09-18","2019-09-18","2021-02-24","2021-04-28","2019-07-03","2020-05-31","2020-05-31","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2020-03-09","2020-03-09","2020-05-31","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-03-07"],"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":[["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","52536016801","PERPHENAZINE ","TAB 8MG","180","Select","Select",""],["","65862069705","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","69315013710","BENZTROPINE ","TAB 1MG","60","Select","Select",""],["","59779050301","OMEPRAZOLE ","TAB 20MG","30","Select","Select",""],["","00832030300","CHLORPROMAZ ","TAB 100MG","60","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65162019010","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","50","Select","Select",""],["","31722063231","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","11822312760","LORATADINE ","TAB 10MG","5","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","21","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","65862019105","CYCLOBENZAPR ","TAB 10MG","21","Select","Select",""],["","65162046510","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00378932132","WIXELA ","AER 250\/50","60","Select","Select",""],["","59762531001","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","55111025960","ZIPRASIDONE ","CAP 80MG","30","Select","Select",""],["","10572010101","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","00185061505","HYDROXYZ ","CAP 50MG","60","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68180044703","QUETIAPINE ","100MG","90","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":""}]}]}