{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LIAGTAEWS","gend":1,"add":"ODAEM 1024DAOR WEIVW","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1967-11-02","age":"","mstatus":"","insh":"7374110*31","cliId":"","pno":"33\/7573980-7","cno":"","email":"","ename":"","eno":"","pphy":"BRITTMAN, STANLEY L MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":"","pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":7576108378,"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":["A41.9","E66.01","N18.4","I12.9","B96.89","N13.6","Z20.822","N32.89","N82.0","N82.1","R32.","K21.9","Z68.42","Z85.41","Z92.3","Z87.891","Z90.710","N13.30","N39.0","Z01.818","N39.42","T83.511A","R78.81","R21.","L29.9","I10.","N18.9","E66.9","N20.0","N13.1","N13.5","A41.50","M54.9","Z12.11","D64.89","N18.32","N21.0","Z96.0","Z16.24","N30.20","Z79.2","Z92.21","Z79.899","Z80.3","Z82.49","Z87.442","R00.0","NO DATA","R63.4","R13.10","R11.0","N30.90","B96.4","Z68.41","R31.9","N17.9","Z13.31","Z01.810","N13.39","Z68.39","C53.9","R31.29","Z68.38","R53.83","Z23.","R07.9","K59.00"],"date":["2021-12-19","2021-12-19","2021-12-21","2021-12-21","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-22","2021-12-19","2021-12-19","2021-12-28","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-21","2021-12-28","2021-09-20","2021-09-20","2021-12-21","2021-12-28","2021-12-28","2020-06-04","2021-12-22","2020-06-04","2020-06-04","2021-07-14","2021-12-21","2021-10-04","2021-12-21","2021-12-21","2020-03-02","2020-04-09","2021-07-14","2020-03-06","2020-03-09","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2021-02-16","2021-12-19","2021-12-22","2020-01-27","2020-01-27","2020-01-27","2020-03-09","2020-03-09","2019-05-09","2019-05-09","2019-11-13","2019-11-13","2019-03-01","2019-09-16","2019-08-08","2019-09-16","2019-09-16","2019-09-16","2019-10-30","2019-10-30","2019-12-09","2019-12-13"],"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":[["","","AMOX\/K","TAB 500-125","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","45","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","","LEVOFLOXACIN","TAB 250MG","","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","51672131201","MUPIROCIN","OIN 0.02","15","Select","Select",""],["","67877021620","CEFUROXIME","TAB 500MG","28","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","10006070166","MELATONIN","TAB 5MG","30","Select","Select",""],["","55111012601","CIPROFLOXACN","TAB 250MG","30","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","GOLYTELY","SOL ","","Select","Select",""],["","","POLY-IRON","CAP 150 FORT","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","11523726804","MIRALAX","POW 3350 NF","765","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","30","Select","Select",""],["","43386058131","METOCLOPRAM","TAB 5MG ODT","28","Select","Select",""],["","00406037605","HYDROCO\/APAP","TAB 5-300MG","24","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","30","Select","Select",""],["","00904645760","DOK","CAP 100MG","10","Select","Select",""],["","65162024709","CHLORTHALID","TAB 25MG","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":""}]}]}