{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONIA   D MCCORMICK","gend":1,"add":"1821 PARKVIEW AVENUE","city":"NORFOLK","state":"VA","zip":"23503-2617","dob":"1987-02-21","age":"","mstatus":"","insh":4334349,"cliId":"","pno":7577741819,"cno":7577741819,"email":"","ename":"","eno":"","pphy":"DOBBIE, ALISON ELIZABETH","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE, STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APARTMENT A","add3":"","madd1":"1821 PARKVIEW AVENUE","madd2":"APARTMENT A","madd3":"","mcity":"NORFOLK","mstate":"VA","mzip":"23503-2617","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.7","F41.1","R10.9","K50.90","K50.80","K92.0","E87.6","F17.210","Z79.899","K29.60","K21.0","R79.89","B37.81","F17.200","R06.02","D72.829","R50.9","Z87.19","R11.2","R10.11","J35.8","J35.01","R49.0","J38.2","R42","K50.919","R10.84","G47.9","R00.0","Z91.19","R53.83","F41.9","H91.90","H81.10","Z30.42","R10.2","G89.29","N39.3","G47.00","Z30.9","R10.31","E27.40","F41.8","Z72.0","Z30.09","R40.0","K21.9","Z88.8","R63.4","Z11.3","R19.7","F43.12","F31.81","F90.2","M53.3","K50.10","K20.9","K29.70","K92.2","K50.00","K25.3","K22.10","K44.9","Z71.3","Z68.26","X58.XXXA","T18.4XXA","R25.1","N91.2","Z01.419","Z20.2","N32.9","K29.00","R31.9","F31.9","R74.8","K52.9","R94.5","F43.10","N94.6","R19.5","Z23","R07.9","F33.9","R79.9","R11.10","R10.10","Z32.02","Z30.013"],"date":["2020-11-09","2019-08-05","2021-03-02","2021-05-06","2020-11-24","2019-01-16","2019-06-15","2020-02-04","2020-03-12","2019-01-15","2019-01-15","2019-01-15","2019-02-13","2021-05-06","2019-05-20","2019-06-22","2019-06-22","2020-02-04","2020-07-28","2019-08-27","2020-02-27","2020-02-27","2020-03-09","2020-01-14","2021-05-06","2020-02-04","2020-03-12","2020-02-04","2020-02-04","2020-03-09","2021-05-06","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2020-06-25","2020-02-27","2019-12-20","2020-01-02","2020-01-02","2020-02-04","2020-10-07","2021-05-06","2019-02-05","2019-09-03","2019-10-09","2020-07-28","2020-02-27","2020-06-03","2020-11-27","2019-01-16","2019-08-05","2019-08-05","2019-08-05","2021-01-04","2019-06-15","2019-01-16","2019-01-15","2019-01-15","2019-01-16","2019-01-15","2019-01-15","2019-01-15","2019-06-15","2019-06-15","2019-09-23","2019-09-23","2019-11-26","2020-05-14","2020-11-27","2020-11-27","2020-11-27","2019-01-16","2019-10-23","2021-01-08","2019-01-10","2019-01-17","2019-01-17","2019-01-30","2019-10-09","2019-09-03","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2019-01-03","2019-07-12","2020-06-25","2020-11-09"],"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":[["","10572030201","PEG-3350\/KCL ","SOL \/SODIUM","4,000.00","Select","Select",""],["","51991001406","MELATONIN ","TAB 3MG","90","Select","Select",""],["","68462024901","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","00591079501","DICYCLOMINE ","TAB 20MG","360","Select","Select",""],["","62756052069","SUMATRIPTAN ","TAB 25MG","9","Select","Select",""],["","50111043401","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","55111053301","DIVALPROEX ","TAB 250MG ER","90","Select","Select",""],["","00591505210","PREDNISONE ","TAB 5MG","90","Select","Select",""],["","59651000205","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00093506201","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","54092019112","PENTASA ","CAP 500MG CR","240","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","00071101668","LYRICA ","CAP 150MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","28","Select","Select",""],["","43598029590","PREGABALIN ","CAP 150MG","60","Select","Select",""],["","00536129701","MECLIZINE ","TAB 12.5MG","60","Select","Select",""],["","51672302002","LIDOCAINE ","OIN 0.05","30","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","00172572960","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","00591079601","SULFASALAZIN ","TAB 500MG","90","Select","Select",""],["","75834002012","VITAMIN ","CAP 50000UNT","8","Select","Select",""],["","43598044774","NICOTINE ","DIS 14MG\/24H","42","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","6","Select","Select",""],["","43547038103","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","64980012950","FLORANEX ","TAB ","30","Select","Select",""],["","37000040514","METAMUCIL ","CAP 0.52GM","60","Select","Select",""],["","66689002316","HYDROCO\/APAP ","SOL 7.5-325","500","Select","Select",""],["","64764030020","ENTYVIO ","INJ 300MG","1","Select","Select",""],["","00363011916","WAL-MUCIL ","CAP 0.52GM","160","Select","Select",""],["","57237000430","FLUCONAZOLE ","TAB 100MG","13","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":""}]}]}