{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHIA WOOD","gend":1,"add":"6305 COLGATE AVE","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1971-02-02","age":"","mstatus":"","insh":"900046143*01","cliId":"1KP1H67HP91","pno":"757\/383-0752","cno":"757\/383-0752","email":"","ename":"","eno":"","pphy":"FRIAS, ANGELINA MD","ppno":"757\/583-2181","pcpadd":"2203 E LITTLE CREEK RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":122721,"pcpname":"Roosevelt Family Practice","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/480-6482","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","D50.9","D72.819","E28.319","E55.9","E78.5","R79.89","M85.80","Z12.31","M25.521","M65.321","M65.331","R56.9","F41.9","M81.0","R52.","M18.10","M25.321","R53.1","R07.81","G40.209","R47.1","Z12.11","Z23.","S53.491A"],"date":["2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-07","2021-06-17","2021-10-12","2021-10-12","2021-10-12","2021-07-15","2021-07-15","2021-08-09","2021-08-12","2021-08-12","2021-09-09","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-10-12","2021-10-12","2021-09-09"],"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":[["","65862024608","LEVETIRACETA","TAB 500MG","180","Select","Select",""],["","51672412501","CARBAMAZEPIN","TAB 400MG ER","180","Select","Select",""],["","536100901","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","180","Select","Select",""],["","69315012710","FOLIC ACID","TAB 1000MCG","90","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","51672412501","CARBAMAZEPINE ER","","180","Select","Select",""],["","65862024608","LEVETIRACETAM ","","180","Select","Select",""],["","536100901","FERROUS SULFATE ","","90","Select","Select",""],["","69452015120","VITAMIN D ","","12","Select","Select",""],["","65862024608","LEVETIRACETAM","","180","Select","Select",""],["","00536100901","FERROUS SULFATE","","90","Select","Select",""],["","72252051002","VALTOCO","10MG","2","Select","Select",""],["","51672412501","CARBAMAZEPINE ER                                                      ","TAB 400MG ER","180","Select","Select",""],["","65162019050","NAPROXEN                                                              ","TAB 500MG","180","Select","Select",""],["","69315012710","FOLIC ACID                                                            ","TAB 1000MCG","30","Select","Select",""],["","65862024608","LEVETIRACETAM                                                         ","TAB 500MG","180","Select","Select",""],["","70377000315","SIMVASTATIN                                                           ","TAB 20MG","90","Select","Select",""],["","00536100901","FERROUS SULFATE                                                       ","TAB 325MG","90","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","12","Select","Select",""],["","72252051002","VALTOCO                                                               ","SPR 10MG","-2","Select","Select",""],["","00591352530","LIDOCAINE                                                             ","PAD 0.05","30","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":""}]}]}