{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ACINEHSNOSLEN A","gend":1,"add":"GRAM   0795EUNEVA ETA","city":"VIRGINIA BEACH","state":"VA","zip":23462,"dob":"1983-01-21","age":"","mstatus":"","insh":"5856327","cliId":"","pno":"4375795709","cno":"","email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA SLEDD","ppno":7573490759,"pcpadd":"600 CRAWFORD ST ,STE 300","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","pcpname":"EVMS MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"5970   MARGATE AVENUE","add3":"","madd1":"5970 MARGATE AVENUE","madd2":"APT C6","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23462-1514","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","R07.9","I10","K21.9","E78.00","Z79.84","E11.40","Z87.891","J34.89","N12","R35.0","R10.32","R11.0","B96.1","Z16.19","R31.0","K42.9","D25.9","R10.814","R91.8","D72.829","E11.65","Z87.442","Z32.02","Z86.31","N20.0","J06.9","H69.82","Z72.0","H92.02","R09.81","R05","F17.210","Z71.6","E11.42","Z79.899","E08.42","L98.7","L02.211","E66.01","L30.9","L81.9","L70.0","Z71.9","N30.01","R31.9","R30.0","R11.2","N93.8","N93.9","Z98.890","N92.0","Z30.42","Z01.419","Z11.3","N94.6","M20.41","M20.42","E11.01","L03.115","I73.9","E11.52","R93.7","N36.1","E11.621","L97.502","S92.253G","R10.9","N39.0","N13.2","Z68.33","F41.9","E11.9","J01.91","Z01.810","Z01.812","R73.9","D25.1","N81.4","E66.9","Z68.32","Z79.1","N85.2","D21.9","E11.41","F31.9","J01.00","L98.499","L97.511","L97.521","L72.9","L81.0","F32.9","D50.9","N30.00","B37.3","Z01.818","M20.30","E55.9","M20.31","M20.32","F41.1","S90.852A","M72.2","T81.31XA","R10.30","R14.0"],"date":["2020-02-22","2021-06-14","2021-09-15","2021-09-15","2021-02-15","2020-11-09","2021-09-07","2021-09-15","2020-02-22","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2021-09-15","2020-03-07","2020-03-07","2020-03-07","2021-09-15","2020-03-07","2020-03-07","2020-03-07","2021-04-29","2020-08-18","2020-08-18","2020-11-09","2021-09-07","2020-08-18","2020-08-18","2020-11-09","2020-08-18","2021-09-15","2021-09-15","2021-02-19","2020-09-14","2020-09-14","2021-06-14","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2021-06-14","2021-04-01","2021-02-19","2021-09-21","2021-03-16","2021-03-16","2021-03-16","2021-09-15","2021-04-29","2021-04-29","2021-04-28","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-06-14","2021-06-14","2021-08-17","2021-09-07","2021-09-13","2021-09-13","2021-09-13","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-21","2019-01-31","2019-08-06","2019-03-06","2019-05-15","2019-05-13","2019-05-13","2019-05-15","2019-05-15","2019-05-22","2019-05-22","2019-06-15","2019-06-26","2019-07-24","2019-07-24","2019-07-24","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-08-29","2019-08-29","2019-10-08","2019-10-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","50228018005","GABAPENTIN","50228018005 GABAPENTIN ","270","Select","Select",""],["","43547028910","BUPROPION","43547028910 BUPROPION ","60","Select","Select",""],["","00172208380","HYDROCHLOROT","00172208380 HYDROCHLOROT ","90","Select","Select",""],["","43547035410","LISINOPRIL","43547035410 LISINOPRIL ","90","Select","Select",""],["","70010006505","METFORMIN","70010006505 METFORMIN ","180","Select","Select",""],["","00093081101","NORTRIPTYLIN","CAP 25MG","30","Select","Select",""],["","08489830910","PEN  NEEDLES","08489830910 PEN  NEEDLES  ","5","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","90","Select","Select",""],["","00169406013","VICTOZA","00169406013 VICTOZA ","9","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","27808008601","HYD","SUS 10-8\/5ML","50","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862039010","ONDANSETRON","65862039010 ONDANSETRON ","12","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","118","Select","Select",""],["","00555087302","MEDROXYPR","00555087302 MEDROXYPR ","30","Select","Select",""],["","65162046650","IBUPROFEN","65162046650 IBUPROFEN ","90","Select","Select",""],["","00143924920","AMOX\/K","00143924920 AMOX\/K ","20","Select","Select",""],["","16729000515","SIMVASTATIN","16729000515 SIMVASTATIN ","90","Select","Select",""],["","00378235193","ESOMEPRA","00378235193 ESOMEPRA ","90","Select","Select",""],["","51672129802","KETOCONAZOLE","51672129802 KETOCONAZOLE ","30","Select","Select",""],["","65862077885","TRI-LO-MILI","65862077885 TRI-LO-MILI ","28","Select","Select",""],["","45802045384","ADAPALENE","45802045384 ADAPALENE ","45","Select","Select",""],["","59267100002","PFIZER","59267100002 PFIZER ","0.3","Select","Select",""],["","16729013616","CLONAZEPAM","16729013616 CLONAZEPAM ","10","Select","Select",""],["","00406051201","OXYCOD\/APAP","00406051201 OXYCOD\/APAP ","30","Select","Select",""],["","11822013729","RA","11822013729 RA ","60","Select","Select",""],["","68462056529","NORGEST\/ETHI","68462056529 NORGEST\/ETHI ","28","Select","Select",""],["","16571066401","METRONIDAZOL","16571066401 METRONIDAZOL ","30","Select","Select",""],["","08290320109","BD  PEN NEEDL","08290320109 BD  PEN NEEDL","100","Select","Select",""],["","16714065202","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","11822073887","ALLERGY\/CONG","TAB 60-120MG","60","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","29300011201","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN OP","3.5","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","65162025306","RANITIDINE","TAB 150MG","60","Select","Select",""],["","60505014100","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","65162037210","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","11822002601","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","53746027101","SMZ-TMP","TAB 400-80MG","10","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00093406701","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}