{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ECYOJNOSTOD","gend":1,"add":"NEDGO 6677B TPA EVA ","city":"NORFOLK","state":"VA","zip":23505,"dob":"1968-07-15","age":"","mstatus":"","insh":"66200210*82","cliId":"","pno":"36\/7575379-3","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/397-6344","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"Medicaid","lob":"OHCC","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":["B20.","I50.9","D72.829","I50.23","Z00.00","Z13.220","I08.3","J96.01","F14.10","F10.10","T40.5X1A","I42.8","J98.4","I11.0","I50.30","R40.0","J81.0","R06.02","I42.0","R06.00","R10.819","R14.3","F14.90","K66.8","R10.12","J44.9","I49.3","I51.7","R94.31","I50.22","I10.","J96.00","Z23.","I50.43","I21.4","Z21.","G93.41","R74.01","E66.9","F17.210","Z82.49","Z82.5","Z88.2","Z68.33","Z20.822","I16.0","G47.33","E78.5","N39.0","J44.1","I43.","Z79.82","Z79.899","Z68.34","Z79.51","Z12.31","R77.8","NO DATA","I31.3","I05.1","R06.89","R07.9","Z86.79","R09.02","I34.0","I35.1","R94.39","B33.24","N17.9","E87.6","E66.09","J98.2","I25.2","I42.9","Z91.14","R07.89","Z68.26","G93.40","F17.200","R91.1","Z91.19","S27.399A","I73.89","F14.188","R07.2","J96.21","I16.1","F32.9","Z80.8","U07.1","I50.41","Z66.","J98.11","I25.10","R00.2","I16.9","R06.03","J14.","J44.0","R59.0","Z59.01","R79.89","F10.20","F14.20","R10.84","Z59.00","I22.2","Z86.19","R73.03","K21.9"],"date":["2022-11-10","2022-09-06","2019-05-09","2022-11-10","2021-03-25","2021-03-25","2021-05-26","2022-10-10","2022-10-10","2021-06-30","2021-05-26","2022-10-10","2021-05-26","2022-11-10","2021-07-01","2021-07-01","2022-06-24","2022-11-13","2021-09-14","2021-11-16","2021-10-20","2021-10-20","2022-05-11","2021-10-27","2021-10-23","2022-10-10","2021-12-13","2022-06-25","2021-11-09","2022-09-02","2022-09-06","2022-10-10","2022-09-06","2022-10-10","2022-10-11","2022-05-11","2021-09-16","2021-09-16","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-06-22","2022-10-10","2022-11-10","2021-09-18","2022-11-10","2022-10-10","2021-11-10","2022-11-13","2021-11-10","2022-06-22","2022-06-22","2021-11-10","2022-06-22","2020-05-07","2021-01-26","2022-11-10","2021-01-25","2021-01-25","2021-10-24","2022-11-10","2021-10-27","2021-10-25","2022-06-25","2021-11-10","2021-12-13","2019-11-07","2022-05-17","2021-10-19","2022-10-10","2021-10-19","2021-10-19","2022-10-10","2022-11-10","2021-11-10","2021-01-26","2021-09-17","2021-09-17","2021-05-25","2021-01-25","2021-05-25","2021-05-25","2022-11-10","2021-05-25","2021-06-30","2021-07-02","2021-06-30","2022-11-10","2022-05-20","2022-06-24","2022-11-10","2022-10-10","2022-10-10","2022-09-27","2022-10-10","2022-06-22","2022-05-17","2022-05-11","2022-05-18","2022-05-11","2022-05-13","2022-07-09","2022-06-27","2022-05-11","2022-02-09","2022-05-17","2022-05-17","2022-11-10","2022-11-10"],"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":[["","00143177101","ISOSORB","TAB 10MG","30","Select","Select",""],["","80681005000","DAILY-VITE","TAB ","30","Select","Select",""],["","00904582360","VITAMIN","TAB 400UNIT","30","Select","Select",""],["","00904679489","ASPIRIN","CHW 81MG","30","Select","Select",""],["","","TIVICAY"," TIVICAY ","30","Select","Select",""],["","","SPIRONOLACT"," SPIRONOLACT ","30","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","","DESCOVY"," DESCOVY ","30","Select","Select",""],["","57896062101","THERA-TABS","TAB ","14","Select","Select",""],["","65162036111","FOLIC","TAB 1MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00078077720","ENTRESTO","TAB 49-51MG","180","Select","Select",""],["","","HYDRALAZINE"," HYDRALAZINE ","60","Select","Select",""],["","","CARVEDILOL","TAB 25MG","","Select","Select",""],["","00904549280","THERA-M","TAB ","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68180098430","BUDESONIDE","SUS 0.5MG\/2","60","Select","Select",""],["","54629003824","MULTI-VITAMN","TAB ","30","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00186091706","PULMICORT","INH 90MCG","1","Select","Select",""],["","68180063809","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","","FUROSEMIDE"," FUROSEMIDE ","30","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","8","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","10135013210","THIAMINE","TAB 100MG","30","Select","Select",""],["","40985027416","D3","CAP 2000UNIT","14","Select","Select",""],["","80681016000","HI","TAB BETA-CAR","14","Select","Select",""],["","79854040055","MULTI-VIT\/","TAB MINERALS","14","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00904693176","PEG","POW ","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","11822033670","RA","TAB 100MG","90","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","6","Select","Select",""],["","00185005501","METOLAZONE","TAB 5MG","2","Select","Select",""],["","63824000820","MUCINEX","TAB 600MG ER","15","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","40985022368","THERAPEUTIC-","TAB M\/LUTEIN","30","Select","Select",""],["","55111058601","AMLOD\/BENAZP","CAP 10-40MG","30","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":[]}},{"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":""}]}]}