{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE SCOTT","gend":1,"add":"1219 MILL STREAM WAY","city":"CHESAPEAKE","state":"VA","zip":"23320-2770","dob":"1975-08-05","age":"","mstatus":"","insh":6529213,"cliId":"","pno":7573515182,"cno":7573193389,"email":"","ename":"","eno":"","pphy":"ABDELSHAHEED, SAMIR T","ppno":7574883333,"pcpadd":"6111 PORTSMOUTH BLVD, ","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":237011445,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":7573193389,"add2":"APT.1","add3":"","madd1":"1219 MILL STREAM WAY","madd2":"APT.1","madd3":"","mcity":"CHESAPEAKE","mstate":"VA","mzip":"23320-2770","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","F31.9","F31.81","Z11.59","M25.522","M25.532","F32.9","J32.9","R29.6","R32","J02.9","J06.9","R07.9","R73.01","E78.5","E55.9","R55","N39.0","R10.2","N93.9","N89.8","Z11.3","R35.0","R31.9","Z87.442","F10.20","M79.602","W19.XXXA","R05","F17.200","W01.0XXA","S50.02XA","Z90.710","F17.210","M18.12","G47.9","B00.9","F31.10","J30.9","W18.49XA","K21.9","F41.9","M79.671","M79.672","Q69.9","Z98.890","G89.29","R00.2","H10.9","N20.0","J98.01","R07.89","J34.89","M19.90","M54.5","Z82.49","Z88.5"],"date":["2021-05-17","2020-04-16","2020-03-09","2021-03-23","2021-01-12","2021-03-11","2021-03-11","2019-12-01","2020-09-11","2019-03-04","2019-03-04","2019-12-01","2019-03-04","2019-12-01","2019-03-11","2020-08-28","2020-08-28","2019-03-11","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2020-08-28","2020-09-11","2020-09-11","2020-09-11","2021-01-05","2021-03-11","2021-03-11","2019-12-01","2021-03-11","2019-04-10","2019-04-10","2019-04-10","2021-01-05","2019-04-10","2020-08-11","2020-08-11","2020-08-11","2021-01-12","2019-04-10","2019-07-03","2019-07-03","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-03-12","2019-03-12","2019-03-12","2019-12-01","2019-12-01","2019-12-01","2019-12-01","2019-12-01","2019-12-01","2019-12-01"],"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":[["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","68462013801","OXCARBAZEPIN ","TAB 300MG","30","Select","Select",""],["","69842000003","FLUTICASONE ","SPR 50MCG","9.9","Select","Select",""],["","31722070430","VALACYCLOVIR ","TAB 500MG","180","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","59779070360","12HR ","TAB 120MG CR","20","Select","Select",""],["","66993068130","OLANZAPINE ","TAB 5MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","47469000465","MELATONIN ","TAB 1MG","180","Select","Select",""],["","68382011214","RISPERIDONE ","TAB 0.25MG","53","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","5","Select","Select",""],["","66993066330","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","5","Select","Select",""],["","00536589653","NICOTINE ","DIS 21MG\/24H","7","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","50428067309","CVS ","CAP 1000UNIT","14","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","77333098310","ZINC ","CAP 220MG","14","Select","Select",""],["","67877024210","QUETIAPINE ","TAB 25MG","90","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","50742018921","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","37000045502","PRILOSEC ","TAB 20MG","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","",""],["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":""}]}]}