{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISHNA PANERU","gend":1,"add":"1325 BUCKINGHAM AVENUE                                      ","city":"NORFOLK                       ","state":"VA","zip":"23508-1312","dob":"1987-12-10","age":"","mstatus":"","insh":10198707,"cliId":"","pno":2068028712,"cno":"","email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA A                                            ","ppno":"","pcpadd":"1701 High St,Ste 300","pcpcity":"Portsmouth                    ","pcpstate":"VA","pcpzip":237043103,"pcpcounty":"","pcpid":"P0060136","pcpname":"PORTSMOUTH FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1325 BUCKINGHAM AVENUE                                      ","madd2":"                                                            ","madd3":"","mcity":"NORFOLK                       ","mstate":"VA","mzip":"23508-1312","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55","D64.9","E03.9","A53.0","D69.6","K21.9","Z11.1","R05","R10.30","J30.9","R09.82","D25.1","N92.0","D50.8","N88.8","D25.9","R00.2","D50.9","Z20.828","R53.83","R42","H57.89","R30.0","N92.6"],"date":["2019-12-03","2021-09-16","2021-09-16","2020-01-15","2021-03-23","2020-01-15","2020-01-15","2020-03-16","2020-04-30","2021-05-14","2020-04-30","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-06-17","2020-06-17","2021-05-14","2021-05-11","2021-05-14","2021-05-14","2021-05-14","2021-06-15","2021-09-16"],"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":[["","59267100003","PFIZER","COVID-19","0.3","Select","Select",""],["","59746012206","MECLIZINE","12.5MG","30","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","69238183007","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","64380080807","IBUPROFEN","600MG","90","Select","Select",""],["","63824000886","MUCINEX","600MG ER","20","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","59746012206","MECLIZINE ","TAB 12.5MG","30","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","69238183007","LEVOTHYROXIN ","TAB 25MCG","90","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","63824000886","MUCINEX ","TAB 600MG ER","20","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":""}]}]}