{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN WELDON","gend":1,"add":"1361   RUDDY OAK COURT                                      ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23453-2830","dob":"1988-11-01","age":"","mstatus":"","insh":10198820,"cliId":"","pno":7572882663,"cno":7572882663,"email":"","ename":"","eno":"","pphy":"ELHASSAN, AMIRA                                             ","ppno":"","pcpadd":"4421 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH                ","pcpstate":"VA","pcpzip":234623114,"pcpcounty":"","pcpid":"P0110911","pcpname":"BON SECOURS TOWN CENTER MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 20                                                      ","add3":"","madd1":"1361   RUDDY OAK COURT                                      ","madd2":"APT 20                                                      ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23453-2830","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O24.919","Z23","Z34.83","Z34.90","Z39.1","Z34.82","O36.8190","O26.613","K83.1","O24.420","Z37.0","O26.62","O72.1","F14.10","F15.10","O99.344","Z11.59","O90.81","O70.0","Z3A.37","Z91.013","O99.334","F17.210","O24.429","O80","F33.1","F43.23","G47.01","F41.1","F90.0","N10"],"date":["2020-04-06","2020-04-06","2020-04-10","2020-05-07","2020-04-10","2020-04-10","2020-04-23","2020-05-04","2020-05-07","2020-05-07","2020-05-08","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-08","2020-05-07","2020-05-07","2020-05-07","2020-05-08","2020-05-08","2021-03-30","2020-09-24","2021-03-30","2021-03-30","2021-03-30","2020-09-27"],"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":[["","00603548221","PROPRANOLOL","10MG","90","Select","Select",""],["","57237001930","DULOXETINE","60MG","30","Select","Select",""],["","49035007860","EQ","SOFTENER","60","Select","Select",""],["","68645056354","IBUPROFEN","800MG","90","Select","Select",""],["","00904759180","FERROUS","325MG","30","Select","Select",""],["","47781017901","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","00591365930","DESVENLAFAX","50MG ER","30","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","99073070822","FREESTYLE TES LITE","LITE","50","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","00591315901","URSODIOL","300MG","42","Select","Select",""],["","33342002208","LEVOFLOXACIN","500MG","10","Select","Select",""],["","00603548221","PROPRANOLOL ","TAB 10MG","90","Select","Select",""],["","57237001930","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","49035007860","EQ ","CAP SOFTENER","60","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","30","Select","Select",""],["","47781017901","AMPHET\/DEXTR ","TAB 20MG","60","Select","Select",""],["","00591365930","DESVENLAFAX ","TAB 50MG ER","30","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00591315901","URSODIOL ","CAP 300MG","42","Select","Select",""],["","33342002208","LEVOFLOXACIN ","TAB 500MG","10","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":""}]}]}