{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACEY   E BURNETT","gend":1,"add":"151   CONVERSE COURT                                        ","city":"NEWPORT NEWS                  ","state":"VA","zip":"23608-9998","dob":"1976-09-04","age":"","mstatus":"","insh":10207572,"cliId":"","pno":4237829809,"cno":4237829809,"email":"","ename":"","eno":"","pphy":"MCCONAUGHY, TERESA L                                        ","ppno":"","pcpadd":"856 J Clyde Morris Blvd","pcpcity":"Newport News                  ","pcpstate":"VA","pcpzip":236011318,"pcpcounty":"","pcpid":"P9059012","pcpname":"RIVERSIDE HOUSE CALLS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"151   CONVERSE COURT                                        ","madd2":"                                                            ","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23608-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.89","R05","R31.9","M54.5","J10.1","R31.29","N95.9","F32.9","H61.21","M54.6","M25.512","M25.511","G89.29","F17.210","S16.1XXA","M54.2","X50.0XXA","R51","J06.9","B97.89","Z20.822","M25.562","S83.412A","X58.XXXA","F32.A","Z87.891","Z79.899","Z88.0","J20.9","D48.5","Z71.9","L91.8"],"date":["2019-11-07","2019-11-07","2019-11-07","2020-08-15","2021-11-06","2021-09-27","2020-04-28","2021-09-27","2020-07-02","2020-08-15","2020-09-27","2020-08-15","2020-08-15","2020-09-27","2020-09-27","2020-09-27","2020-09-27","2020-09-27","2021-10-24","2021-10-24","2021-11-06","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-06","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":["","","","",null,"","","","","","","","","","","","","",null,null,null,null,null,null,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":[["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","49884068905","METOCLOPRAM","10MG","40","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00904530760","BANOPHEN","50MG","30","Select","Select",""],["","42806071501","BENZONATATE ","CAP 200MG","20","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","63824000850","MUCINEX ","TAB 600MG ER","14","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","49884068905","METOCLOPRAM ","TAB 10MG","40","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00904530760","BANOPHEN ","CAP 50MG","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","",""],["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":""}]}]}