{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAHSTINYIA TAYLOR","gend":1,"add":"721   NANSEMOND DRIVE                                       ","city":"NEWPORT NEWS                  ","state":"VA","zip":"23605-9998","dob":"1992-11-27","age":"","mstatus":"","insh":10173648,"cliId":"","pno":3479715160,"cno":3479715160,"email":"","ename":"","eno":"","pphy":"DOWLING, NEQUITA                                            ","ppno":"","pcpadd":"2148 W Mercury Blvd","pcpcity":"Hampton                       ","pcpstate":"VA","pcpzip":236663111,"pcpcounty":"","pcpid":"P9059016","pcpname":"RIVERSIDE MERCURY WEST","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"721   NANSEMOND DRIVE                                       ","madd2":"                                                            ","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23605-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","Z13.1","Z11.3","Z13.228","Z33.1","J45.909","Z32.01","O99.519","Z36.89","Z3A.29","Z23","Z11.2","Z11.8","Z36.3","O36.5990","O99.210","Z3A.35","O26.90","O62.2","Z3A.39","O62.9","O47.1","Z3A.00","O62.8","Z3A.40","O76","Z34.03","O98.32","O99.214","O48.0","O99.513","K59.00","O34.13","A59.01","M54.5","Z37.0","Z91.013","Z91.018","Z91.048","Z00.00","D25.9","O77.9","Z39.1","Z34.82","Z34.83","G89.18","O41.1230","Z37.9","B00.1","S00.521A","R21","R22.0","Z87.2","Z79.899","F17.290","Z88.3","L01.00","Z32.02","N73.0","B96.89","R10.84","R11.0","Z91.09","M43.6","M54.2","V89.2XXD","M54.9","M54.6","T14.90XA","S16.1XXA","W00.0XXA","Y92.480","S29.012A","J45.20","Z88.8","S29.019A","N39.0","Z20.2","N89.8","Z79.1","O26.891","R10.9","Z3A.08","O99.89","R10.2","O99.331","O99.511","Z34.91","Z76.89","R20.0","R42","M79.10","Z80.3","Z84.81","Z13.220","R20.2","J02.0","J02.9","L29.8","Z91.89","L02.412","F41.1","O9A.211","O99.351","O99.321","T43.3X2A","G47.9","F12.10","Z3A.01","R45.851","T50.901A","K14.8","T43.3X5A","O23.41","O99.891","Z3A.10","T50.905A"],"date":["2020-06-01","2019-04-24","2019-04-24","2019-04-24","2019-05-13","2020-06-01","2019-05-09","2019-05-09","2019-07-25","2019-05-13","2019-06-04","2019-06-04","2019-06-04","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2019-07-23","2019-07-27","2019-07-24","2019-07-23","2019-07-25","2021-08-24","2019-07-25","2019-07-27","2019-07-27","2019-07-26","2019-07-26","2019-07-26","2019-07-27","2019-07-26","2019-07-26","2019-07-26","2020-02-21","2020-01-08","2019-07-27","2021-10-04","2021-10-04","2019-07-26","2020-09-30","2019-07-30","2019-07-27","2019-07-30","2019-07-27","2019-07-27","2019-07-28","2019-07-30","2019-07-30","2019-08-01","2019-08-01","2019-08-01","2019-08-01","2019-08-01","2021-02-19","2021-10-04","2021-08-26","2019-08-01","2019-09-10","2019-11-05","2020-06-01","2019-11-05","2019-11-05","2021-10-04","2019-12-08","2020-02-21","2019-12-18","2020-02-21","2020-01-08","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2021-10-04","2021-10-04","2020-02-21","2020-06-01","2020-10-31","2020-07-27","2020-06-01","2021-10-04","2021-10-04","2020-07-27","2020-07-27","2021-10-04","2021-10-04","2021-10-04","2020-07-27","2020-07-27","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-10-31","2020-10-31","2020-10-31","2020-10-31","2021-02-19","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-25","2021-08-26","2021-08-26","2021-10-04","2021-10-04","2021-10-04","2021-08-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"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":[["","65162044210","MECLIZINE","25MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","70010077005","METHOCARBAM","750MG","60","Select","Select",""],["","00591252001","CHLORZOXAZON","500MG","90","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","77333071510","PRENATAL","","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","59779001922","ALLERGY","25MG","24","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","40","Select","Select",""],["","51991074790","DULOXETINE","30MG","30","Select","Select",""],["","60505025203","TIZANIDINE","4MG","60","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","30","Select","Select",""],["","68180012101","CEPHALEXIN ","CAP 250MG","28","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","70010077005","METHOCARBAM ","TAB 750MG","60","Select","Select",""],["","00591252001","CHLORZOXAZON ","TAB 500MG","90","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","77333071510","PRENATAL ","TAB ","30","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","59779001922","ALLERGY ","CAP 25MG","24","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","12","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","28","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","60","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":""}]}]}