{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA   N SMITH","gend":1,"add":"415   SAVAGE DRIVE                                          ","city":"NEWPORT NEWS                  ","state":"VA","zip":"23602-5612","dob":"1998-12-06","age":"","mstatus":"","insh":10228509,"cliId":"","pno":7577857900,"cno":7577857900,"email":"","ename":"","eno":"","pphy":"COCHRAN, DONALD L","ppno":"","pcpadd":"640 North St","pcpcity":"Portsmouth                    ","pcpstate":"VA","pcpzip":237042415,"pcpcounty":"","pcpid":"P0140239","pcpname":"MD EXPRESS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"UNIT E                                                      ","add3":"","madd1":"415   SAVAGE DRIVE                                          ","madd2":"UNIT E                                                      ","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23602-5612","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N10","Z34.02","Z11.3","Z13.228","Z3A.15","R30.0","O35.9XX0","O35.2XX0","Z3A.20","F41.1","R06.02","Z34.03","Z13.1","Z23","O26.893","R10.2","O99.013","D64.9","O99.613","K59.00","Z3A.35","R10.30","R00.2","O26.03","Z3A.36","Z79.899","Z11.2","Z11.8","O48.0","Z37.0","O76","O36.8130","Z3A.40","O99.344","F41.9","O70.1","O99.214","Z87.440","O36.8120","Z3A.00","Z39.1","O90.89","M79.89","M25.579","Z53.21","O72.1","O99.345","G57.91","F41.8","R60.0","O72.2","G62.89","O99.215","R21","L70.0","Z30.017","Z32.02","R07.89","Z87.09","R07.9","M79.641","M79.642","J45.20","M54.5","M25.50","Z71.9","M25.571","S93.401A","S93.421A","W23.1XXA","X50.1XXA","S99.911A","R35.0","N93.9","B35.9","B35.1","L85.3","Z51.81","L30.1","R42","M54.2","I49.9","Z82.49","R06.00","Z87.898","R00.0","K21.9","L70.9","L30.9","S90.222A","M54.50","Z97.5","L60.8","N64.89"],"date":["2020-02-18","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-03-08","2020-03-30","2020-03-30","2020-03-30","2020-04-20","2020-10-11","2020-06-01","2020-06-01","2021-10-01","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-13","2020-07-13","2020-07-13","2020-07-20","2021-07-01","2020-07-20","2020-07-20","2021-11-01","2020-08-05","2020-08-05","2020-08-17","2020-08-23","2020-08-18","2020-08-17","2020-08-18","2020-08-17","2020-08-23","2020-08-18","2020-08-17","2021-06-10","2020-08-18","2020-08-18","2020-08-21","2020-08-23","2020-11-24","2020-08-22","2020-08-22","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-09-09","2021-11-01","2020-09-29","2021-02-12","2021-06-24","2020-10-11","2021-06-15","2020-11-24","2020-11-24","2020-11-18","2020-11-24","2020-11-18","2021-11-01","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2021-10-01","2021-10-01","2021-02-26","2021-03-29","2021-03-22","2021-03-29","2021-03-29","2021-06-10","2021-06-11","2021-06-15","2021-06-15","2021-06-24","2021-06-24","2021-06-25","2021-07-01","2021-07-01","2021-07-30","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-11-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","60","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","00904645780","DOK","100MG","60","Select","Select",""],["","00472011745","TRETINOIN","0.03%","45","Select","Select",""],["","55111013781","ZENATANE","40MG","60","Select","Select",""],["","63304061650","DOXYCYC","100MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","20","Select","Select",""],["","51672300302","HYDROCORT","2.50%","113.4","Select","Select",""],["","00168020260","CLINDAMYCIN","1%","60","Select","Select",""],["","65862007930","TERBINAFINE","250MG","84","Select","Select",""],["","61748030411","MYORISAN","40MG","30","Select","Select",""],["","51672127501","CLOTRIMAZOLE","1%","105","Select","Select",""],["","16714008210","HYDROXYZ","25MG","30","Select","Select",""],["","59746017509","PREDNISONE","20MG","5","Select","Select",""],["","16714079904","CETIRIZINE","10MG","90","Select","Select",""],["","00536440601","VITAMIN","25MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","60","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","16714036004","MONO-LINYAH","0.25-35","28","Select","Select",""],["","65162019011","NAPROXEN","500MG","60","Select","Select",""],["","00904759180","FERROUS","325MG","60","Select","Select",""],["","00168003315","BETAMETH","0.10%","15","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","20","Select","Select",""],["","68645014059","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","00904645780","DOK ","CAP 100MG","60","Select","Select",""],["","00472011745","TRETINOIN ","CRE 0.00025","45","Select","Select",""],["","55111013781","ZENATANE ","CAP 40MG","60","Select","Select",""],["","61748030411","MYORISAN ","CAP 40MG","60","Select","Select",""],["","63304061650","DOXYCYC ","CAP 100MG","30","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","51672300302","HYDROCORT ","CRE 0.025","113.4","Select","Select",""],["","00168020260","CLINDAMYCIN ","GEL 0.01","60","Select","Select",""],["","65862007930","TERBINAFINE ","TAB 250MG","84","Select","Select",""],["","51672127501","CLOTRIMAZOLE ","CRE 0.01","105","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","16714079904","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","00536440601","VITAMIN ","TAB 25MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","00173071920","FLOVENT ","AER 110MCG","12","Select","Select",""],["","16714036004","MONO-LINYAH ","TAB 0.25-35","28","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","60","Select","Select",""],["","00168003315","BETAMETH ","OIN 0.001","15","Select","Select",""],["","49348007644","URINARY ","TAB 95MG","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","",""],["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":""}]}]}