{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LEAHCIMLLAW E  ","gend":0,"add":"C 1 6001 TPAYKWP DROFWAR","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1951-01-07","age":"","mstatus":"","insh":"73000910*064","cliId":"","pno":"17\/7572353-7","cno":"","email":"","ename":"","eno":"","pphy":"RYAL, JENNIFER L MD","ppno":"757\/446-8920","pcpadd":"SUITE 445 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S29.011A","K21.9","K40.90","Z93.1","R10.9","R06.9","I95.9","Z93.0","J90.","J18.1","K59.00","R53.1","R10.31","J69.0","J91.8","E03.9","I25.10","C32.9","I95.89","C14.0","R91.8","L76.22","L02.213","Z85.819","R60.9","J93.9","A41.9","N32.89","K46.9","F32.9","E78.5","H91.90","R13.10","J47.9","I49.3","M54.9","R47.89","T44.4X6A","Z87.19","Z45.2","K40.91","I50.33","J96.21","J86.9","J43.9","Z98.890","R57.8","J81.1","D64.9","R41.82","E27.40","I50.32","J96.11","J96.12","N17.9","R33.8","R65.21","I48.0","D70.8","E87.2","E87.1","E83.42","R79.89","Z20.828","T81.89XA","J96.01","E44.0","S32.509A","S32.512D","S32.592D","E87.6","S32.9XXA","J18.9","I48.91","J95.03","N48.89","N52.9","Z46.82","Z87.891","I80.203","K56.7","R52.","Z74.3","T14.90XA","S32.512A","S32.592A","R55.","I95.1","D23.9","R09.02","M54.6","M54.2","Z86.79","J44.9","L03.90","A31.0","I08.0","R57.1","Z79.2","R60.0","I67.82","R64.","B37.89","I47.1","T81.42XA","T81.32XA","Z16.11","E86.1","T81.30XA","J98.4","J15.6","I11.0","J96.10","D48.5","R68.89","K40.20","S21.109A","J95.860","S22.39XA","G93.41","T17.890A","E46.","B37.49","D63.8","N40.1","R20.0","R29.898","R20.2","D50.9","K92.1","I67.9","W19.XXXA","T81.31XD","S32.502D","Z43.0","Z43.1","R13.12","Z92.3","Z92.21","Z99.81","Z79.82","H90.3","K94.23","I63.9","G93.40","I45.10","M25.552","R29.6","S21.90XA","R10.2","S33.5XXA","R63.4","E86.0","Z96.652","K94.20","Z00.00","J96.22","E87.4","I47.2","D62.","I48.92","E87.0","Z99.11","Z46.59","C01.","Z48.813","M17.11","Z79.52","Z95.810","S21.212D","G47.30","I08.3","I77.810","R53.81","M79.89","M62.89","H52.4","H52.03","H52.223","H25.9","Z13.5","R29.818","R25.1","S22.42XA","L21.9","D69.2","L81.4","R07.9","G89.12","R41.89","Z86.73","Z53.09","T14.8XXA","L98.9","Z23.","M25.511","M25.512","Z87.2","Z85.810","M47.816","M81.0","Z12.11","K31.6","M48.55XA","M79.18","G89.29","M48.02","M47.812","M62.511","M62.512","S32.020A","M80.00XA","T85.528D","T85.528A","I31.3","M43.06","Z13.820","M89.9","B37.0","I10.","Z95.5","Z86.010","M54.59","G47.00","R47.9","Z87.01","Z82.49","Z80.3","R91.1","M51.36","T17.908D","R93.89","Z86.19","Z85.89"],"date":["2020-03-04","2020-03-04","2021-06-30","2022-07-15","2022-07-02","2020-03-12","2022-09-09","2022-08-22","2020-06-22","2020-04-13","2022-08-22","2020-06-22","2020-03-24","2022-01-26","2020-03-14","2022-08-22","2022-08-22","2020-03-17","2022-08-22","2020-07-04","2022-03-30","2020-04-14","2020-05-06","2022-08-22","2020-04-20","2020-05-02","2020-06-07","2020-04-29","2020-03-12","2020-06-08","2022-08-22","2022-08-22","2022-10-13","2022-04-20","2020-06-22","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2020-04-21","2020-04-10","2020-04-27","2020-06-01","2022-01-26","2020-06-08","2020-06-06","2020-04-16","2020-05-22","2020-06-08","2020-05-06","2022-08-27","2021-06-15","2021-06-15","2020-07-04","2020-05-06","2020-05-06","2020-06-05","2020-07-19","2020-06-01","2020-06-03","2020-06-01","2020-06-01","2022-10-21","2020-06-01","2020-06-04","2020-06-05","2022-10-13","2020-07-04","2020-07-09","2020-07-15","2020-07-23","2020-07-23","2020-10-12","2020-07-23","2022-10-13","2021-10-22","2021-10-22","2022-07-02","2022-10-21","2020-04-25","2020-04-15","2020-06-22","2020-06-22","2020-06-22","2020-06-22","2020-07-12","2020-06-29","2022-08-27","2020-11-17","2021-06-15","2022-05-16","2022-03-17","2021-12-30","2022-06-09","2021-12-30","2022-01-26","2020-04-11","2020-04-13","2020-04-21","2020-04-27","2020-04-29","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-04","2020-06-01","2020-06-01","2020-06-07","2020-06-04","2020-06-06","2020-07-15","2020-07-19","2020-11-17","2022-07-15","2021-07-16","2020-04-10","2020-04-14","2020-04-15","2020-04-29","2020-04-29","2022-09-09","2020-04-29","2020-04-29","2020-04-29","2020-04-30","2022-04-13","2020-04-30","2020-05-04","2020-05-04","2020-05-13","2020-06-29","2020-07-19","2020-07-19","2020-07-19","2022-07-15","2020-07-19","2022-08-22","2022-08-22","2020-07-19","2020-07-19","2021-03-02","2022-07-16","2020-04-30","2020-04-30","2020-06-22","2020-06-29","2022-08-22","2020-06-25","2020-07-09","2021-06-30","2021-06-30","2022-08-22","2020-04-27","2022-08-23","2020-03-31","2020-04-10","2020-04-10","2020-04-10","2020-04-10","2020-04-10","2020-04-10","2020-04-18","2020-04-17","2020-06-08","2020-06-08","2020-06-08","2020-04-27","2020-04-27","2020-06-08","2020-06-08","2020-06-05","2020-06-05","2020-09-02","2020-09-02","2020-09-02","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-04-29","2020-04-29","2020-05-27","2020-11-17","2020-11-17","2020-11-17","2020-03-13","2020-04-13","2020-04-29","2020-04-29","2020-04-29","2020-05-19","2020-11-06","2020-11-06","2022-04-13","2022-05-16","2022-01-26","2022-05-04","2022-03-28","2022-10-25","2022-07-13","2022-08-23","2022-03-30","2022-05-16","2022-04-13","2022-04-13","2022-04-13","2022-05-22","2022-05-22","2022-05-17","2022-05-17","2022-07-02","2022-07-18","2022-08-26","2022-03-28","2022-05-17","2022-05-17","2022-06-09","2022-08-22","2022-08-22","2022-08-22","2022-05-16","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-03-30","2022-05-17","2022-04-20","2022-04-20","2022-04-20","2022-04-20"],"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":[["","00093735156","LANSOPRAZOLE","CAP 30MG DR","90","Select","Select",""],["","52817031910","BACLOFEN","TAB 5MG","-90","Select","Select",""],["","16729044917","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","00115703301","FLUDROCORT","TAB 0.1MG","360","Select","Select",""],["","16714069803","VALACYCLOVIR","TAB 500MG","90","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","64980043501","MIDODRINE","TAB 10MG","120","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","3","Select","Select",""],["","53489014310","SPIRONOLACT","TAB 25MG","15","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","15","Select","Select",""],["","62037099905","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","25","Select","Select",""],["","70436015301","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","63323030478","PIPER\/TAZOBA","INJ 36-4.5GM","3","Select","Select",""],["","00005434462","CENTRUM","LIQ ","472","Select","Select",""],["","59762007401","HYDROCORT","TAB 10MG","-26","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","45","Select","Select",""],["","60505079204","ENOXAPARIN","INJ 40\/0.4ML","-6","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00591570801","CLINDAMYCIN","CAP 150MG","-90","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","00904640180","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","00904146516","FEROSUL","ELX 220\/5ML","150","Select","Select",""],["","11917011600","COMP","LIQ MINERAL","480","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","6","Select","Select",""],["","51672129802","KETOCONAZOLE","CRE 0.02","-30","Select","Select",""],["","66758019005","KLOR-CON","TAB 20MEQ ER","30","Select","Select",""],["","70461012103","FLUAD","INJ 2021-22","0","Select","Select",""],["","66689002316","HYDROCO\/APAP","SOL 7.5-325","100","Select","Select",""],["","52817033050","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","00904698160","BISACODYL","SUP 10MG","12","Select","Select",""],["","23155060601","GLYCOPYRROL","TAB 1MG","90","Select","Select",""],["","16714049602","CLOTRIM\/BETA","CRE 1-0.05%","45","Select","Select",""],["","70000029902","MUCUS+CHST","LIQ 100\/5ML","474","Select","Select",""],["","62011008901","TUSSIN","LIQ 100\/5ML","474","Select","Select",""],["","00904676316","ROBAFEN","SYP 100\/5ML","474","Select","Select",""],["","00054028259","ALENDRONATE","SOL 70\/75ML","300","Select","Select",""],["","50383077932","LACTULOSE","SOL 10GM\/15","450","Select","Select",""],["","60258000601","PHOS-NAK","POW CONCENTR","7","Select","Select",""],["","43598021025","SSD","CRE 0.01","25","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"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":""}]}]}