{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER   V MEAD","gend":1,"add":"143 PINE CHAPPEL ROAD","city":"HAMPTON","state":"VA","zip":"23666-4273","dob":"1995-09-16","age":"","mstatus":"","insh":8108250,"cliId":"","pno":7578371181,"cno":7578371181,"email":"","ename":"","eno":"","pphy":"LARKIN, TIMOTHY PATRICK","ppno":7578501311,"pcpadd":"191 Fox Hill Rd Ste D, ","pcpcity":"Hampton","pcpstate":"VA","pcpzip":236692360,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":7573583006,"add2":"APT 9","add3":"","madd1":"143 PINE CHAPPEL ROAD","madd2":"APT 9","madd3":"","mcity":"HAMPTON","mstate":"VA","mzip":"23666-4273","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O80","Z3A.40","Z37.0","Z32.01","M25.512","M25.532","V49.40XA","Y92.414","N89.8","A59.9","N93.0","O26.893","R10.2","M53.3","O99.013","D50.9","Z3A.35","Z88.0","Z86.32","O99.02","D56.3","O99.824","F17.210","O26.892","R06.02","J06.9","D64.9","O99.512","O99.012","Z3A.21","N76.0","R45.851","A74.9","V87.7XXA","N93.9","B96.20","B96.89","A56.2","R30.0","N92.6","Z13.1","Z39.1","B34.9","R51","R09.81","R05","R50.9","Z87.891","F31.0","Z36.89","O35.2XX0","Z36.86","Z3A.20","O36.8130","O47.9","Z3A.39","O62.9","R50.81","Z20.2","F39","O99.342","F14.11","Z3A.24","O99.323","Z3A.32","Z3A.31","O99.89","Z3A.38","M54.9","T14.90XA","Z20.828","R11.0","M79.10","Z04.6","R46.89","M54.5","R31.9","R35.0","M25.511","Z11.59","F31.9"],"date":["2019-05-31","2019-05-31","2019-05-31","2019-10-31","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2021-02-11","2020-12-17","2020-07-20","2019-05-20","2019-05-20","2019-04-27","2019-05-28","2019-04-27","2019-04-27","2021-02-11","2019-05-28","2019-05-31","2019-05-31","2019-05-31","2020-12-17","2019-02-13","2019-01-19","2020-08-31","2019-05-20","2019-01-19","2019-01-19","2019-01-19","2020-10-09","2020-12-10","2020-12-17","2020-02-07","2020-05-10","2020-05-10","2020-10-09","2020-05-10","2021-02-11","2021-02-11","2019-03-29","2019-06-03","2019-11-17","2019-11-17","2019-11-17","2020-08-31","2019-11-17","2019-11-17","2020-12-10","2019-01-15","2019-01-15","2019-01-15","2019-01-15","2019-04-08","2019-05-28","2019-05-28","2019-05-28","2019-11-17","2020-12-10","2021-04-23","2019-02-13","2019-04-08","2019-02-13","2019-04-08","2019-04-08","2019-04-19","2019-05-20","2019-05-20","2019-05-20","2020-02-07","2020-12-10","2020-08-31","2020-08-31","2020-12-10","2020-12-10","2019-05-20","2019-05-20","2019-05-20","2020-06-16","2020-08-31","2020-12-11"],"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":[["","29300022701","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","64679096105","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","60","Select","Select",""],["","51672413001","LAMOTRIGINE ","TAB 25MG","46","Select","Select",""],["","00378334053","XULANE ","DIS 150-35","3","Select","Select",""],["","65862001330","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","59746021106","CYCLOBENZAPR ","TAB 5MG","5","Select","Select",""],["","11822046713","PAIN ","325MG","20","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","14","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":""}]}]}