{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   REGORNOSNEB C","gend":0,"add":"ES 4449LP YBL","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1957-09-12","age":"","mstatus":"","insh":"87600210*13","cliId":"","pno":"03\/7576696-9","cno":"757\/309-6966","email":"","ename":"","eno":"","pphy":"WHITEHURST-DOSS, SUE NP","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":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.673","M20.40","R79.89","R03.0","M48.00","M54.2","B20.","F41.9","F15.10","Z23.","C44.329","F15.20","L03.115","I87.2","F32.9","G62.9","E78.5","Z11.3","M54.5","D04.39","L76.21","Z98.890","Z85.828","S10.93XA","L98.9","Z48.817","Z87.891","M77.42","M20.42","T84.84XA","T84.498A","A41.9","R06.03","I10.","S01.81XA","Z48.1","G89.18","Z21.","Z88.5","Z88.8","L03.90","Z09.","J18.9","R35.0","D48.5","L72.9","Z71.9","M79.604","L25.9","L57.0","L65.9","NO DATA","Z13.220","J96.01","Z96.641","Z79.82","Z79.899","Z91.048","Z20.828","F90.2","L72.3","S90.412A","L08.9","R60.0","R52.","Z13.31"],"date":["2022-09-08","2022-06-14","2020-09-01","2022-06-14","2020-09-01","2022-01-13","2022-10-13","2021-04-07","2021-04-07","2022-10-13","2022-01-13","2020-08-07","2022-07-27","2020-09-23","2021-06-30","2022-10-13","2022-10-13","2022-10-13","2020-11-04","2021-12-02","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-09-08","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2020-08-20","2020-08-19","2022-10-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-09-08","2022-08-19","2020-08-20","2020-12-31","2021-06-23","2021-06-23","2021-06-23","2022-07-23","2021-06-02","2021-06-02","2021-06-02","2022-10-13","2022-10-13","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-12-22","2021-08-30","2022-10-13","2022-10-13","2020-08-18","2022-07-23","2022-08-19"],"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":[]},{"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":[["","31722099601","HYDROCO\/APAP","TAB 5-325MG","4","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","31722059730","RITONAVIR","TAB 100MG","60","Select","Select",""],["","59676056201","PREZISTA","TAB 600MG","60","Select","Select",""],["","60219172206","ETRAVIRINE","TAB 200MG","60","Select","Select",""],["","00006022761","ISENTRESS","TAB 400MG","60","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","68180063509","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","90","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","59676057101","INTELENCE","TAB 200MG","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","51672421503","METRONIDAZOL","GEL 0.01","120","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","60","Select","Select",""],["","50419082901","FINACEA","AER 0.15","50","Select","Select",""],["","00299382060","METROGEL","GEL 0.01","60","Select","Select",""],["","21922000407","DESONIDE","OIN 0.0005","60","Select","Select",""],["","65862014930","FINASTERIDE","TAB 5MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","45802093716","HYDROCORT","LOT 0.025","59","Select","Select",""],["","16714047801","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00536252525","CAPSAICIN","CRE 0.00025","60","Select","Select",""],["","00713055593","DOXYCYC","CAP 100MG","18","Select","Select",""],["","00143211205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","59417010110","VYVANSE","CAP 10MG","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":""}]}]}