{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUANITA   K GRANT","gend":1,"add":"360 ROSEMAN COURT","city":"NEWPORT NEWS","state":"VA","zip":"23608-2732","dob":"1997-04-06","age":"","mstatus":"","insh":3207943,"cliId":"","pno":7577191951,"cno":7577191951,"email":"","ename":"","eno":"","pphy":"MCGAVERN, MEGAN B","ppno":7572344285,"pcpadd":"12652 JEFFERSON AVE, ","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":236024392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":7572565857,"add2":"APT 1F","add3":"","madd1":"360 ROSEMAN COURT","madd2":"APT 1F","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23608-2732","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","M54.9","Z3A.23","R51","R35.0","N89.8","E66.9","Z68.43","G47.10","R06.83","E66.01","M62.838","R30.0","R39.15","O26.892","M54.5","R10.2","O99.012","Z98.890","O86.02","R10.30","R16.2","R11.2","R63.5","R06.02","Z82.49","Z00.00","Z13.1","Z13.220","R10.33","K42.9","M62.08","Z98.891","T88.8XXA","M79.81","R16.0","R18.8","R10.84","T88.8XXD","Z30.019","R82.90","G43.109","G47.00","Z79.899","Z82.0","L03.818","L20.9","R51.9","D64.9","R11.0","Z32.01","D50.8","E53.8","Z3A.27","Z23","O09.899","Z67.91","M70.032","F17.290","O35.9XX0","O99.212","Z3A.20","O34.211","Z34.83","D62","O99.214","O90.81","O99.824","Z3A.39","Z37.0","O99.02","D50.9","Z88.0","O34.219","O99.019","Z3A.00","Z41.2","Z39.2","O72.1","N99.820","T81.43XA","O86.19","N73.9","K59.00","O99.63","S13.4XXA","Z36.9","Z3A.15","O36.5930","Z36.89","O99.213","Z3A.31","K64.8","F17.210","K59.09","G89.18","N30.00","Z72.51","A60.04","M79.10","R52","B00.9","Z87.440"],"date":["2021-04-15","2019-05-27","2019-05-27","2020-09-13","2020-05-14","2020-09-10","2021-03-23","2021-04-16","2021-04-20","2021-04-20","2021-04-16","2021-04-16","2020-09-10","2019-05-16","2019-05-27","2019-09-24","2019-05-27","2019-05-27","2019-10-10","2019-10-13","2020-02-13","2019-11-22","2021-01-07","2020-02-13","2020-02-13","2020-02-13","2020-12-22","2020-12-22","2020-12-22","2021-01-07","2021-01-07","2021-01-07","2020-01-07","2019-10-10","2019-10-11","2019-11-11","2019-11-22","2020-01-07","2020-01-07","2020-12-22","2020-12-22","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2021-02-27","2021-02-27","2021-04-15","2021-04-15","2021-04-17","2019-04-01","2019-09-24","2019-01-31","2019-06-26","2019-06-26","2019-06-26","2019-06-26","2020-02-19","2021-04-15","2019-05-03","2019-05-03","2019-05-03","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-10-10","2019-09-12","2019-09-12","2019-09-12","2019-09-13","2019-10-08","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2021-05-05","2019-04-01","2019-04-01","2019-07-22","2019-07-22","2019-07-22","2019-07-22","2021-03-23","2021-03-23","2021-03-23","2019-09-13","2020-09-10","2020-09-10","2020-09-10","2020-09-13","2020-09-13","2020-09-13","2020-09-13"],"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":[["","62559043130","HYDROCORTISO ","CRE 0.025","30","Select","Select",""],["","00536408501","PRENATAL ","TAB 28-0.8MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","20","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00093026230","FLUOCINONIDE ","CRE 0.0005","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","120","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","00093227434","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","00536440601","VITAMIN ","TAB 25MG","30","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","30","Select","Select",""],["","61442010210","DICLOFENAC ","TAB 50MG DR","14","Select","Select",""],["","10631040701","PROCTOSOL ","CRE 0.025","28.35","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","76385012350","METHOCARBAM ","TAB 500MG","40","Select","Select",""],["","31722070430","VALACYCLOVIR ","TAB 500MG","40","Select","Select",""],["","68682045570","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","14","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","50428096918","CVS ","TAB 625MG","30","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","68180088673","NIKKI ","TAB 3-0.02MG","28","Select","Select",""],["","10135012301","ACETAMIN ","TAB 325MG","30","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","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":""}]}]}