{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CATHY RAYSON","gend":1,"add":"215   MONTICELLO COURT                                      ","city":"NEWPORT NEWS                  ","state":"VA","zip":"23602-8118","dob":"1963-11-23","age":"","mstatus":"","insh":10267962,"cliId":"","pno":6055538330,"cno":6055538330,"email":"","ename":"","eno":"","pphy":"FRANKLIN JR, WILLIAM A","ppno":"","pcpadd":"2110 Hartford Rd Ste A","pcpcity":"Hampton                       ","pcpstate":"VA","pcpzip":236666600,"pcpcounty":"","pcpid":"P0136471","pcpname":"INTEGRITY HEALTHCARE CORPORATION","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 1D                                                      ","add3":"","madd1":"215   MONTICELLO COURT                                      ","madd2":"APT 1D                                                      ","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23602-8118","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D61.818","R16.2","B18.2","F19.11","R59.1","D50.9","J44.9","M19.90","Z87.891","Z87.01","R16.1","Z78.0","Z12.31","L30.9","D22.5","D17.9","Z71.9","D69.6","D72.819","N64.89","R59.0","K76.89","Z12.11","K57.30","K64.0","I83.813","I83.899","J40","H65.93","R05","J98.4","K43.2","B19.20","J45.909","Z01.811","K43.9","J45.40","Z79.51","Z23","J18.9","R91.8","Z01.818","R16.0","Z79.899","Z79.52","K40.90"],"date":["2021-11-10","2020-11-04","2021-11-16","2021-11-10","2020-11-04","2021-11-10","2021-11-16","2021-11-16","2021-11-16","2021-10-08","2021-11-10","2020-11-05","2020-11-05","2020-11-06","2020-11-06","2021-02-05","2020-11-06","2020-11-10","2020-11-10","2020-11-10","2021-11-10","2020-12-22","2021-11-10","2021-02-26","2021-02-26","2021-11-16","2021-11-10","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-11-16","2021-08-23","2021-10-06","2021-10-08","2021-11-16","2021-11-10","2021-11-16","2021-10-08","2021-11-16","2021-11-09","2021-11-10","2021-11-10","2021-11-16","2021-11-16","2021-11-17"],"priorHcc":[null,"",null,null,"",null,null,null,null,"",null,"","","","","","","","","",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":[["","59779030602","CVS","","238","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","68462053253","CLOBETASOL","0.05%","50","Select","Select",""],["","72626270101","SOFOS\/VELPAT","400-100","28","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","00536100901","FERROUS","325MG","45","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","64380071307","BENZONATATE","200MG","20","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","120","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","00378064205","PREDNISONE","20MG","10","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.25","Select","Select",""],["","59779030602","CVS ","POW ","238","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","64380071307","BENZONATATE ","CAP 200MG","20","Select","Select",""],["","68462053253","CLOBETASOL ","SOL 0.0005","50","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","72626270101","SOFOS\/VELPAT ","TAB 400-100","28","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","45","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","120","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","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":""}]}]}