{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVEN   M YANCY","gend":1,"add":"1001 ATLANTIS DRIVE","city":"VIRGINIA BEACH","state":"VA","zip":"23451-5706","dob":"1990-09-18","age":"","mstatus":"","insh":7903186,"cliId":"","pno":7577763936,"cno":"               ","email":"","ename":"","eno":"","pphy":"PATEL, JITENDRA M","ppno":7574713100,"pcpadd":"2020 S Independence Blvd Ste 1, ","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234534776,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":7577762154,"add2":"APARTMENT 201","add3":"","madd1":"1001 ATLANTIS DRIVE","madd2":"APARTMENT 201","madd3":"","mcity":"VIRGINIA BEACH","mstate":"VA","mzip":"23451-5706","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O26.891","R10.2","Z3A.12","O26.892","R10.84","M54.5","H92.02","K08.89","D50.9","O35.9XX0","O09.292","O99.212","Z3A.18","O26.93","O09.299","O99.213","Z3A.28","O09.293","Z3A.29","Z3A.34","Z30.42","R10.9","R51","R11.2","R19.7","N83.202","O99.331","R00.0","Z3A.17","O99.891","Z3A.27","Z3A.31","R82.90","O10.013","Z3A.36","O32.1XX0","Z37.0","Z3A.37","O99.355","R29.810","R53.1","G51.0","O13.5","Z86.19","O09.892","O36.5930","Z3A.32","O26.893","G89.18","L08.89","Z48.01","Z79.52","Z87.891","Z88.0","Z91.018","Z91.030","M26.629","H66.003","H92.03","R11.0","F17.210","O09.90","Z11.3","O60.03","Z34.83","O99.820","O99.343","F31.9","F43.10","F41.9","Z20.822","Z79.899","Z82.3","Z82.5","Z83.3","L08.9","Z98.891","O10.919","Z87.898","O35.1XX0","Z02.83","B20","O36.5920","O10.912","Z87.59","Z3A.26","R10.10","O99.012","D64.9","O21.2","O99.322","F12.10","Z86.59","Z79.82","O09.93","O10.913","F32.9","O99.613","K21.9","O99.353","G89.29","I10","Z3A.22","O26.92","Z3A.30","Z36.85","Z3A.35","O90.89","R51.9","G97.1","O99.53","J45.909","O99.345","Z91.5","O36.80X0","O16.2","Z3A.14","O23.42","O99.332","Z87.440","O99.013","O99.513","Z3A.33","O99.324","F19.94","Z23","F12.90","O99.62","Z88.1","O21.9","Z3A.10","O99.89","O34.81","N89.8","O23.12","R10.30","R30.0","N30.00","O99.342","Z82.49","E66.01","M54.9","Z91.013"],"date":["2020-09-21","2021-02-12","2020-09-21","2021-01-02","2021-01-22","2020-10-27","2020-10-27","2021-05-12","2020-10-27","2020-11-03","2021-01-05","2021-01-05","2020-11-03","2021-03-09","2021-01-08","2021-03-09","2021-01-13","2021-03-09","2021-01-15","2021-02-26","2019-01-22","2021-04-09","2020-09-21","2021-01-22","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-10-27","2021-02-12","2021-01-05","2021-02-02","2021-02-23","2021-03-10","2021-03-09","2021-03-10","2021-03-10","2021-03-10","2021-03-18","2021-03-18","2021-03-18","2021-04-09","2021-03-18","2021-03-18","2020-09-30","2021-03-03","2021-02-09","2021-03-03","2021-03-11","2021-04-09","2021-04-09","2021-04-09","2021-05-12","2021-05-12","2021-05-12","2021-04-09","2021-05-12","2019-04-15","2019-04-15","2019-04-15","2020-11-28","2021-02-23","2020-11-17","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-13","2021-03-10","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-13","2021-03-13","2021-04-09","2021-04-09","2021-03-10","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2021-01-05","2021-01-05","2021-03-13","2020-12-29","2021-01-02","2021-01-02","2021-01-22","2021-02-12","2021-01-02","2021-01-02","2021-02-12","2021-01-02","2021-01-13","2021-03-03","2021-01-22","2021-02-12","2021-03-10","2021-01-22","2021-05-12","2021-03-18","2020-12-01","2021-01-02","2021-01-26","2021-02-23","2021-03-02","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2020-09-30","2020-09-30","2020-09-30","2020-11-28","2020-11-28","2021-02-12","2021-02-12","2021-02-12","2021-02-16","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2020-09-21","2020-09-03","2020-09-21","2020-09-21","2020-09-21","2020-11-28","2020-11-28","2020-11-28","2020-11-28","2020-11-28","2020-11-28","2021-02-19","2021-05-12","2021-05-12"],"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":[["","00536123441","ASPIRIN ","TAB 81MG EC","60","Select","Select",""],["","00574722612","COMPRO ","SUP 25MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","60","Select","Select",""],["","51991029201","OXCARBAZEPIN ","TAB 150MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","12","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","15","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","40","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59779030501","CLOTRIMAZOLE ","CRE 0.01","14.2","Select","Select",""],["","65162089129","MOMETASONE ","SPR 50MCG","17","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","50428477071","CVS ","CAP 25MG","24","Select","Select",""],["","80681013800","CALCIUM\/D3 ","TAB 600MG","60","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","50428264783","STOOL ","CAP 100MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","24","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","23155022701","ACYCLOVIR ","TAB 400MG","70","Select","Select",""],["","59779001951","ALLERGY ","CAP 25MG","24","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","20","Select","Select",""],["","59779010112","PAIN ","TAB 500MG","12","Select","Select",""],["","71930005552","APAP\/CODEINE ","300-30MG","15","Select","Select",""],["","53746061705","TRAMADL\/APAP ","37.5-325","15","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":""}]}]}