{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELLA   M CROSSLEY","gend":1,"add":"721 CHIMNEY HILL PKWY APT 320","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1954-01-20","age":"","mstatus":"","insh":"900042183*01","cliId":"3CX6KP4NW64","pno":"757\/867-0840","cno":"757\/867-0840","email":"","ename":"","eno":"","pphy":"KAMEL, NANCY MD","ppno":"757\/821-2088","pcpadd":"1232 PERIMETER PKWY SUITE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":188240,"pcpname":"TPMG CORPORATE LANDING INTERNAL FAM MEDICINE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/821-2081","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D51.9","E03.9","E78.5","I10.","R73.03","M00.9","M48.061","Z98.890","J45.909","M19.90","Z98.1","M51.36","M51.37","M43.17","M43.16","K21.9","G62.9","G47.00","Z86.19","R26.9","G56.01","G56.02","F33.9","G56.03","Z68.27","M11.261","M53.2X6","M48.062","M48.07","M25.461","K59.09","J45.20","B18.2","Z87.442","Z90.49","Z79.899","Z87.891","Z01.810","M25.561","M54.5","M43.26","Z01.818","Z86.79","Z87.09","M17.11","M47.816","Z20.822","Z68.25","Z00.00","Z68.26","R19.7","R10.819","E66.9","K76.9","Z79.891","Z79.52","Z12.31","R10.9","R19.4","K59.1","Z20.828","Z12.11","N39.0","Z88.8"],"date":["2021-04-29","2021-04-20","2021-04-20","2021-08-27","2021-04-20","2021-01-28","2021-01-28","2021-04-30","2021-04-30","2021-04-30","2021-04-15","2021-06-02","2021-04-15","2021-04-15","2021-04-15","2021-08-10","2021-01-29","2021-01-29","2021-04-30","2021-02-04","2021-03-23","2021-04-30","2021-04-29","2021-06-02","2021-04-30","2021-06-16","2021-01-22","2021-01-22","2021-01-22","2021-01-26","2021-01-22","2021-01-22","2021-01-22","2021-04-30","2021-01-22","2021-04-30","2021-04-30","2021-01-18","2021-06-30","2021-07-01","2021-04-15","2021-01-18","2021-01-18","2021-01-18","2021-01-25","2021-01-15","2021-01-18","2021-06-30","2021-10-21","2021-10-13","2021-08-10","2021-08-10","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-09-10","2021-09-14","2021-09-14","2021-10-21","2021-10-16","2021-07-28","2021-11-17","2021-09-14"],"priorHcc":["","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,"","","","","","",null,null,null,null,null,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":[["","00406012305","HYDROCO\/APAP ","5-325MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","63","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","45","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","270","Select","Select",""],["","68462019005","NAPROXEN ","500MG","90","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","42","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","42","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","30","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","65162010250","GABAPENTIN","300MG","270","Select","Select",""],["","00406012505","HYDROCODONE\/ACETAMINOPHEN","10-325MG","42","Select","Select",""],["","70010077001","METHOCARBAMOL","750MG","42","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE","4MG","-42","Select","Select",""],["","42806040021","METHYLPREDNISOLONE DOSE PACK","4MG","-21","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5MG","30","Select","Select",""],["","16729018201","HYDROCHLOROTHIAZIDE","12.5MG","90","Select","Select",""],["","68462019005","NAPROXEN","500MG","-90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE","10MG","45","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","63","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","0.01","-100","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","65162010250","GABAPENTIN                                                            ","CAP 300MG","270","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 10MG","45","Select","Select",""],["","00093314705","CEPHALEXIN                                                            ","CAP 500MG","63","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE                                              ","TAB 4MG","-42","Select","Select",""],["","68462019005","NAPROXEN                                                              ","TAB 500MG","90","Select","Select",""],["","70010075401","METHOCARBAMOL                                                         ","TAB 500MG","60","Select","Select",""],["","68180071909","AMLODIPINE BESYLATE                                                   ","TAB 2.5MG","-30","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","1","Select","Select",""],["","16729018201","HYDROCHLOROTHIAZIDE                                                   ","TAB 12.5MG","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM                                                     ","GEL 0.01","100","Select","Select",""],["","42806040021","METHYLPREDNISOLONE DOSE PACK                                          ","TAB 4MG","-21","Select","Select",""],["","68382050010","OMEPRAZOLE                                                            ","CAP 40MG","180","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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}