{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   L WALKINSHAW","gend":1,"add":"7336 CARY AVE","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1963-10-17","age":"","mstatus":"","insh":"900049062*01","cliId":"9RQ2CK5CD03","pno":"804\/683-7035","cno":"804\/683-7035","email":"","ename":"","eno":"","pphy":"DOEREN, BRIAN MD","ppno":"757\/941-5600","pcpadd":"263 MCLAWS CIRCLE SUITE 105","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":159520,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/564-0557","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","I95.9","F25.9","Z00.00","R26.9"],"date":["2021-11-02","2021-08-02","2021-09-20","2021-08-02","2021-09-20"],"priorHcc":[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":[["","51660052605","ALLERGY RELIEF","10MG","8","Select","Select",""],["","68382000106","PAROXETINE HCL","40MG","31","Select","Select",""],["","13107003134","MIRTAZAPINE","15MG","31","Select","Select",""],["","65862059505","DIVALPROEX SODIUM ER","500MG ER","62","Select","Select",""],["","00591024110","LORAZEPAM","1MG","60","Select","Select",""],["","00832003800","OXYBUTYNIN CHLORIDE","5MG","31","Select","Select",""],["","60505257909","ATORVASTATIN CALCIUM","20MG","31","Select","Select",""],["","00904053061","TAB-A-VITE W\/BETA CAROTENE","BETA CAR","31","Select","Select",""],["","24208079062","NEOMYCIN\/POLYMYXIN\/GRAMICIDIN","OP","10","Select","Select",""],["","68382080510","TRAZODONE HYDROCHLORIDE","50MG","31","Select","Select",""],["","50458055101","INVEGA","6MG","30","Select","Select",""],["","00904053980","THERA","","31","Select","Select",""],["","57896060101","THERA-TABS","","31","Select","Select",""],["","79854040055","MULTI-VITAMIN\/MINERALS","MINERALS","31","Select","Select",""],["","00904675859","ROBAFEN DM COUGH","10-100MG","240","Select","Select",""],["","68382000106","PAROXETINE HCL                                                        ","TAB 40MG","31","Select","Select",""],["","13107003134","MIRTAZAPINE                                                           ","TAB 15MG","31","Select","Select",""],["","51660052605","ALLERGY RELIEF                                                        ","TAB 10MG","8","Select","Select",""],["","65162075750","DIVALPROEX SODIUM ER                                                  ","TAB 500MG ER","60","Select","Select",""],["","50458055101","INVEGA                                                                ","TAB 6MG","30","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM                                                  ","TAB 20MG","31","Select","Select",""],["","69315090510","LORAZEPAM                                                             ","TAB 1MG","62","Select","Select",""],["","00904053980","THERA                                                                 ","TAB ","31","Select","Select",""],["","68382080510","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","31","Select","Select",""],["","00904053061","TAB-A-VITE W\/BETA CAROTENE                                            ","TAB BETA CAR","31","Select","Select",""],["","70954000520","OXYBUTYNIN CHLORIDE                                                   ","TAB 5MG","62","Select","Select",""],["","79854040055","MULTI-VITAMIN\/MINERALS                                                ","TAB MINERALS","31","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE                                               ","SOL 0.0012","473","Select","Select",""],["","00904675859","ROBAFEN DM COUGH                                                      ","LIQ 10-100MG","240","Select","Select",""],["","24208079062","NEOMYCIN\/POLYMYXIN\/GRAMICIDIN                                         ","SOL OP","10","Select","Select",""],["","57896060101","THERA-TABS                                                            ","TAB ","31","Select","Select",""],["","58160088752","FLUARIX QUADRIVALENT 2021-2022                                        ","INJ 2021-22","0","Select","Select",""],["","10147095303","PALIPERIDONE ER                                                       ","TAB ER 6MG","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":""}]}]}