{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LACHELLE LAWS","gend":1,"add":"1103 GREENWOOD STREET","city":"NORFOLK","state":"VA","zip":"23513-3222","dob":"1987-02-04","age":"","mstatus":"","insh":7699908,"cliId":"","pno":7579491487,"cno":7579491487,"email":"","ename":"","eno":"","pphy":"KUMAR, ANITA C","ppno":7573051797,"pcpadd":"828 Healthy Way Ste 220, ","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234627960,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 303","add3":"","madd1":"1103 GREENWOOD STREET","madd2":"                                                            ","madd3":"","mcity":"NORFOLK","mstate":"VA","mzip":"23513-3222","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R45.851","F32.9","Z60.9","Z91.14","Z91.018","Z87.891","R53.83","F51.09","F17.200","H17.9","H52.7","H53.8","H52.10","Z97.3","R44.0","F31.60","F19.94","F12.10","Z03.818","F17.210","Z79.899","F31.70","Z51.81","F43.10","F12.20","F23","F25.0","H53.149","R00.2","D21.9","D64.9","R87.612","F31.32","N93.9","R31.9","R82.4","R80.9","Z32.02","Z86.39","Z86.79","Z86.19","Z96.22","Z86.69","Z87.42","Z82.49","Z01.89","F31.64","F31.9","F19.950","F51.05","F31.77","F12.988","F31.4","F34.1","F41.9","Z62.810","Z30.430","Z12.4","Z83.3","R68.89","F29","Z01.419","Z11.3","Z68.24","H16.002","H57.12","H57.89","F33.1","F41.1","Z30.46"],"date":["2020-09-11","2020-08-18","2020-09-07","2020-08-18","2020-01-17","2020-02-04","2019-08-03","2019-08-03","2020-11-13","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-08-18","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2021-02-03","2020-11-13","2021-02-03","2020-11-13","2020-10-21","2019-08-20","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2021-01-04","2019-10-10","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2021-02-24","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-09-08","2020-09-11","2020-10-08","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2019-08-03","2019-08-02","2019-08-02","2019-08-02","2021-02-24","2020-11-04","2019-09-18","2019-09-18","2020-09-22","2020-11-04","2019-10-23","2019-10-23","2019-12-27","2019-12-27","2019-12-27","2020-08-31","2020-09-15","2020-11-04"],"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":[["","42806016105","HYDROXYZ ","TAB 50MG","120","Select","Select",""],["","50428014677","CVS ","CAP 2000UNIT","30","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","30","Select","Select",""],["","29300013901","DIVALPROEX ","TAB 250MG DR","60","Select","Select",""],["","67877014601","TEMAZEPAM ","CAP 15MG","30","Select","Select",""],["","00536379001","VITAMIN ","CAP 2000UNIT","30","Select","Select",""],["","67877025001","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","17478071311","OFLOXACIN ","DRO 0.3% OP","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":""}]}]}