{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIANIE   L DIEHL","gend":1,"add":"1005 DANIEL MALONEY DRIVE                                   ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23464-8254","dob":"1990-04-10","age":"","mstatus":"","insh":7891479,"cliId":"","pno":7572327107,"cno":7572327107,"email":"","ename":"","eno":"","pphy":"JUER, ROBERT                                                ","ppno":"","pcpadd":"828 Healthy Way Ste 220","pcpcity":"Virginia Beach                ","pcpstate":"VA","pcpzip":234627960,"pcpcounty":"","pcpid":"P0060053","pcpname":"BONSECOURS MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1005 DANIEL MALONEY DRIVE                                   ","madd2":"                                                            ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23464-8254","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.1","R59.1","R09.89","J35.1","J34.89","J06.9","F43.23","F41.1","G56.03","N92.6","Z13.220","Z13.29","Z76.89","Z68.34","J30.2","Z01.84","E78.00","E66.01","Z68.35","Z11.1","L30.0","L85.3","Z34.90","E66.9","O36.80X9","Z36.0","O21.9","Z12.4","N64.4","O26.891","M54.2","M43.6","Z3A.11","Z88.6","Z34.01","Z36.9","Z33.1","Z36.1","Z34.82","Z3A.21","Z36.3","T78.49XA","Z3A.30","R51.9","O9A.213","R10.9","V43.52XA","Y93.89","Y92.410","S39.81XA","O26.893","O99.213","Z3A.32","Z79.1","O9A.219","V89.2XXA","T14.90XA","R69","Z34.83","Z3A.33","J31.0","J32.9","H10.33","L30.9","J45.902","L50.8","K90.49","L20.83","Z20.828","O98.513","R05","R68.89","U07.1","Z79.82","Z3A.35","Z91.09","O98.53","Z3A.36","Z39.1","Z3A.37","Z79.899","Z03.71","O09.43","Z3A.38","Z86.16","Z3A.39","Z3A.40","O99.214","Z37.0","O48.0","O77.0","O70.0","Z01.812","Z20.822","O69.81X0","O80","O47.03","Z39.2","Z13.32"],"date":["2020-06-29","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2019-01-18","2019-03-07","2019-05-30","2019-07-03","2019-08-07","2019-07-03","2019-07-03","2019-07-03","2019-07-03","2019-07-09","2019-07-31","2019-08-07","2019-08-07","2021-08-21","2019-11-26","2020-03-13","2020-03-13","2021-04-19","2021-07-28","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-03-01","2021-03-04","2021-07-28","2021-03-04","2021-03-04","2021-03-04","2021-03-22","2021-06-28","2021-04-19","2021-04-19","2021-08-31","2021-05-10","2021-05-10","2021-07-13","2021-07-13","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-08-21","2021-09-13","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-09-20","2021-08-03","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-12","2021-09-02","2021-08-21","2021-08-21","2021-09-02","2021-09-21","2021-08-21","2021-08-21","2021-08-21","2021-08-24","2021-08-31","2021-09-03","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2021-09-21","2021-09-13","2021-09-24","2021-09-21","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-21","2021-09-21","2021-09-24","2021-09-24","2021-09-02","2021-11-05","2021-11-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null]}},{"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":[["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","16714008210","HYDROXYZ","25MG","60","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","68645056259","IBUPROFEN","600MG","90","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","90","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":""}]}]}