{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHAKERIA   S HOLDER","gend":1,"add":"1134   VIRGINIA AVENUE                                      ","city":"PORTSMOUTH                    ","state":"VA","zip":"23707-3656","dob":"1992-09-18","age":"","mstatus":"","insh":10203285,"cliId":"","pno":7576395940,"cno":7576395940,"email":"","ename":"","eno":"","pphy":"RYAL, JENNIFER L                                            ","ppno":"","pcpadd":"825 Fairfax Ave,Ste H","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"P0114071","pcpname":"PORTSMOUTH FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"F                                                           ","add3":"","madd1":"1134   VIRGINIA AVENUE                                      ","madd2":"F                                                           ","madd3":"","mcity":"PORTSMOUTH                    ","mstate":"VA","mzip":"23707-3656","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","L30.9","B96.89","B35.4","N89.8","J45.909","F17.210","Z88.5","A63.0","Z11.3","L29.9","R63.1","F32.9","Z71.6","F17.200","N63.20","R51","K02.9","K04.7","N64.89","Z20.828","A59.01","N76.6","Z11.4","Z30.09","Z11.59","F41.9","Z77.098","R10.84","R11.2","R19.7","R11.10","Z97.5","T14.91XA","F10.10","F10.120","Y90.1","T50.992A","F10.920","R94.31","T50.901A","J06.9","N72","R30.0","Z13.6","K08.89","B37.3","I10","Z53.21","R06.02","K92.0","Y90.7","Z79.1","R10.31","R10.32"],"date":["2021-09-06","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2021-08-15","2021-08-15","2019-12-20","2020-01-07","2021-05-25","2020-01-09","2020-01-09","2020-04-30","2020-01-09","2021-06-09","2020-05-11","2020-04-30","2021-08-15","2020-04-30","2020-05-11","2021-03-02","2021-09-06","2020-10-07","2021-05-25","2021-05-25","2020-10-07","2020-11-04","2020-11-04","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-10-04","2021-03-29","2021-03-29","2021-05-10","2021-05-25","2021-05-25","2021-05-25","2021-08-15","2021-09-06","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-21","2021-10-21"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","",null,null,null,null,null,null,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":[["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","12","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","14","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","10","Select","Select",""],["","68645056259","IBUPROFEN","600MG","20","Select","Select",""],["","16714029904","AMOXICILLIN","500MG","21","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","16714035101","FLUOXETINE","10MG","60","Select","Select",""],["","57237004101","PENICILLN","500MG","28","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","200","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","16714008210","HYDROXYZ","25MG","30","Select","Select",""],["","43598065530","BUPROPN","150MG XL","30","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","14","Select","Select",""],["","68645014059","FAMOTIDINE ","TAB 20MG","10","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","16714029904","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","16714035101","FLUOXETINE ","CAP 10MG","60","Select","Select",""],["","57237004101","PENICILLN ","TAB 500MG","28","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","200","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","12","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","43598065530","BUPROPN ","TAB 150MG XL","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","",""],["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":""}]}]}