{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATORYA   R JONES","gend":1,"add":"200   WARKS CRESCENT                                        ","city":"NEWPORT NEWS                  ","state":"VA","zip":"23608-0105","dob":"1989-08-09","age":"","mstatus":"","insh":10172063,"cliId":"","pno":7575270439,"cno":7575270439,"email":"","ename":"","eno":"","pphy":"ROSS, GLENN S                                               ","ppno":"","pcpadd":"11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS                  ","pcpstate":"VA","pcpzip":236064390,"pcpcounty":"","pcpid":"P0152604","pcpname":"SENTARA FAMILY MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 103                                                     ","add3":"","madd1":"200   WARKS CRESCENT                                        ","madd2":"APT 103                                                     ","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23608-0105","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F41.9","F43.12","M25.532","M54.2","V49.40XA","Y92.410","M62.838","Z88.0","S80.02XA","M25.561","W19.XXXA","Y92.831","M25.562","R42","M25.50","N30.00","N89.8","F32.9","Z30.09","Z01.419","V89.9XXS","G51.0","Z20.2","Z32.02","M79.642","W26.0XXS","W26.0XXA","S61.412D","W26.9XXD","Y93.G1","Z20.828","U07.1","J06.9"],"date":["2021-07-23","2019-04-11","2021-07-23","2019-09-20","2020-05-07","2019-09-20","2019-09-20","2020-05-07","2019-09-20","2019-12-13","2019-12-13","2019-12-13","2019-12-12","2019-12-13","2020-02-07","2020-01-07","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-01-28","2020-02-07","2020-05-07","2020-03-04","2020-03-04","2020-12-18","2020-10-01","2020-10-01","2020-12-18","2020-12-18","2020-12-18","2021-09-01","2021-07-23","2021-07-23"],"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":[["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","00378110101","PRAZOSIN","1MG","90","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","00378110101","PRAZOSIN ","CAP 1MG","90","Select","Select",""],["","69097084805","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","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","",""],["No","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":""}]}]}