{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIVLEKHTIMS ","gend":0,"add":"TECNIRP 90734N TPA LP NO","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1962-02-24","age":"","mstatus":"","insh":"75400210*65","cliId":"","pno":"35\/7577444-5","cno":"","email":"","ename":"","eno":"","pphy":"REISER, PAMELA C MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":"","pcpname":"EVMS ACADEMIC PHYS AND SURGEONS HEALTH SVCS FOUNDATION","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":["F11.20","R07.9","L03.116","R21.","R10.9","I10.","R51.9","R06.83","R35.1","K59.00","N40.0","K21.9","F17.200","R94.31","Z68.24","J44.9","Z23.","R07.89","T50.901A","R06.02","Z20.822","M19.90","E78.5","F17.210","Z79.51","Z79.899","Z01.818","M54.12","R07.81","H11.001","M50.00","Z98.1","S46.102A","M48.02","M96.1","L03.039","B95.61","B35.1","L60.0","M25.511","S46.101A","G89.29","Z68.22","Z80.9","Z86.010","K63.5","M47.812","R05.9","Z79.52","R73.9","N52.9","M25.512","M54.2","I49.9","R42.","J06.9","Z20.828","R52.","K29.90","M54.9","R51.","K59.09","R19.5","R68.89","I70.722","S29.011A","S46.912A","M50.30","M75.102","R91.8","G89.18","Z79.1","Z87.891","R53.83","V58.89","R39.11","Z13.31","I70.222","M20.41","M20.42","Z11.4","L85.3","Z53.21","Z53.20","M54.10","Z53.29","Z98.890","R10.12","J02.9","H54.61","H11.153","H25.13","H16.401","H43.813","R11.2","T38.0X1A","J44.1","M79.603","E86.0"],"date":["2022-11-21","2022-10-20","2020-11-05","2020-11-05","2022-09-14","2022-09-14","2022-08-09","2021-03-01","2021-03-01","2022-09-14","2022-04-14","2022-10-21","2022-11-21","2021-05-04","2021-10-27","2022-11-25","2021-11-04","2022-10-21","2021-06-07","2022-10-29","2022-10-19","2022-09-03","2021-11-04","2022-11-25","2022-02-22","2022-09-10","2021-10-14","2022-11-21","2019-02-27","2019-08-08","2019-08-30","2022-10-21","2020-02-28","2021-11-22","2021-11-22","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2019-11-26","2019-11-26","2022-10-18","2019-11-26","2020-11-25","2020-11-25","2020-11-25","2022-10-21","2021-10-03","2021-10-03","2021-11-04","2022-02-01","2021-09-06","2022-11-21","2022-09-10","2022-07-26","2020-05-26","2020-07-26","2020-07-26","2019-02-10","2022-09-14","2020-09-25","2020-11-20","2020-11-20","2020-11-20","2021-05-10","2021-09-06","2021-09-06","2021-05-25","2021-05-25","2021-10-27","2021-12-16","2022-09-03","2022-10-19","2021-12-16","2020-01-28","2021-01-05","2020-12-01","2021-05-05","2021-05-05","2021-05-05","2022-09-14","2022-09-14","2022-07-26","2022-09-03","2022-10-18","2022-02-22","2022-08-09","2022-02-22","2022-02-05","2022-02-05","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-08-09","2022-09-10","2022-10-19","2022-10-21","2022-10-20"],"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":[["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","72140000021","EUCERIN","CRE ","454","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","31722071101","SILDENAFIL","TAB 100MG","30","Select","Select",""],["","45963043963","CONSTULOSE","SOL 10GM\/15","237","Select","Select",""],["","","CLOBETASOL"," CLOBETASOL ","15","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","90","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","","LACTULOSE","SOL 10GM\/15","","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00172392660","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","CYCLOBENZAPR","TAB 7.5MG","","Select","Select",""],["","","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","4","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","57237003105","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","24","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","","TADALAFIL","TAB 10MG","","Select","Select",""],["","68645048054","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","","HYOSCYAMINE","SUB 0.125MG","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","49035044206","EQ","GUM 4MG CINN","50","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","CEPHALEXIN","CAP 250MG","","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":""}]}]}