{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY MASSIE","gend":1,"add":"915  S PRINCE WILLIAM COURT                                 ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23452-4632","dob":"1996-02-08","age":"","mstatus":"","insh":10194198,"cliId":"","pno":7574347935,"cno":7574347935,"email":"","ename":"","eno":"","pphy":"AUSTIN, DEMETRIA                                            ","ppno":"","pcpadd":"2800 Godwin Blvd","pcpcity":"Suffolk                       ","pcpstate":"VA","pcpzip":234348038,"pcpcounty":"","pcpid":"P9444483","pcpname":"LEGACY CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APARTMENT 5                                                 ","add3":"","madd1":"915  S PRINCE WILLIAM COURT                                 ","madd2":"APARTMENT 5                                                 ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23452-4632","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z32.01","Z34.00","Z12.4","R87.610","Z36.3","Z36.89","O09.30","Z34.90","Z34.82","Z31.430","O44.42","Z39.1","O32.1XX0","Z23","O99.210","O48.1","O48.0","O99.324","Z37.0","O98.82","Z3A.40","O99.214","F12.90","O69.81X0","Z87.891","Z79.899","A74.9","E66.9","O80","Z30.09","J96.01","J98.01","R06.02","Z11.59","R07.89","R06.2","R00.0","D72.829","R79.89","Z68.36","R07.9","J93.0","J96.00","J93.9","S27.0XXA","Z45.2","Z46.82","J98.11","O99.53","T17.890A","R73.9","T38.0X5A","O90.81","D64.9","O99.345","F32.9","Z78.1","Z82.49","Z83.3","Z83.49","R53.81","Z51.5","J45.909","R68.89","T50.905A","J45.20","R53.83","N63.20","N64.4","Z30.430","E78.2","E03.9","Z00.00","E55.9"],"date":["2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-09-10","2020-01-06","2019-08-20","2019-08-22","2019-08-22","2019-08-22","2019-09-10","2019-09-19","2019-10-15","2019-11-05","2019-12-03","2020-01-09","2020-01-12","2020-01-12","2020-01-13","2020-01-12","2020-01-13","2020-01-12","2020-01-12","2020-01-12","2020-04-07","2020-04-08","2020-01-12","2020-04-07","2020-01-13","2020-01-27","2020-04-13","2020-04-07","2020-04-13","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-13","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-13","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2020-04-13","2020-04-13","2020-04-11","2020-04-13","2020-04-13","2021-10-26","2021-06-11","2020-05-04","2020-05-04","2020-05-08","2021-06-11","2021-06-11","2021-06-11","2021-06-21"],"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":[["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","00904198260","MAPAP","325MG","30","Select","Select",""],["","59746017206","PREDNISONE","5MG","10","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","00173072020","FLOVENT","220MCG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","00904198260","MAPAP ","TAB 325MG","30","Select","Select",""],["","59746017206","PREDNISONE ","TAB 5MG","10","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","00173072020","FLOVENT ","AER 220MCG","12","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":""}]}]}