{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MEKIA L MCADOO","gend":1,"add":"924 IVY AVENUE","city":"NEWPORT NEWS","state":"VA","zip":"23607-6311","dob":"1978-01-19","age":"","mstatus":"","insh":7378008,"cliId":"","pno":"9192258619, 7575938763","cno":7577061976,"email":"","ename":"","eno":"","pphy":"MAJUMDAR, SOHINI","ppno":7578271940,"pcpadd":"2148 W Mercury Blvd, ","pcpcity":"Hampton","pcpstate":"VA","pcpzip":236663111,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"APT H","add3":"","madd1":"924 IVY AVENUE","madd2":"APT H","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23607-6311","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","Z23","F17.200","E11.65","E11.9","I10","Z79.4","E78.2","Z12.4","R87.619","M54.2","R10.9","N12","E11.43","B37.3","Z12.31","R68.89","M25.612","B00.9","R87.618","Z32.02","Z11.3","N72","F32.3","F51.04","A41.9","N10","B96.20","F17.210","Z88.0","Z88.5","Z79.899"],"date":["2021-02-01","2019-10-21","2019-10-21","2021-03-03","2019-10-21","2020-08-25","2021-03-03","2019-10-21","2020-08-25","2020-08-25","2021-02-12","2019-05-03","2019-05-05","2020-08-25","2020-08-25","2020-08-25","2021-02-12","2020-06-11","2020-06-11","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2019-02-19","2019-02-19","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03"],"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":[["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","69315013710","BENZTROPINE ","TAB 1MG","60","Select","Select",""],["","62559015901","FLUVOXAMINE ","TAB 50MG","45","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","90","Select","Select",""],["","00527179001","FLUPHENAZINE ","TAB 5MG","30","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","00781707787","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","17478071130","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","63304090430","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","49483062350","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","35046000392","MELATONIN ","TAB 10MG CR","30","Select","Select",""],["","31722053301","METHOCARBAM ","TAB 500MG","40","Select","Select",""],["","00193708050","CONTOUR ","TES BLD GLUC","50","Select","Select",""],["","08496311601","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","53885039310","ONETOUCH ","MIS LANCETS","100","Select","Select",""],["","00002831501","HUMULIN ","INJ U-100","10","Select","Select",""],["","00169750111","NOVOLOG ","INJ 100\/ML","10","Select","Select",""],["","00172541211","FLUCONAZOLE ","TAB 150MG","1","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}