{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONIA   D MCCORMICK","gend":1,"add":"1821 PARKVIEW AVENUE","city":"NORFOLK","state":"VA","zip":"23503-2617","dob":"1987-02-21","age":"","mstatus":"","insh":4334349,"cliId":"","pno":7577741819,"cno":"","email":"","ename":"","eno":"","pphy":"DOBBIE, ALISON ELIZABETH","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE, STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"","pcpname":"EVMS MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APARTMENT A","add3":"","madd1":"1821 PARKVIEW AVENUE","madd2":"APARTMENT A","madd3":"","mcity":"NORFOLK","mstate":"VA","mzip":"23503-2617","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","G89.29","K50.90","G47.00","F17.200","Z30.9","J35.8","J35.01","R49.0","J38.2","R42","R11.2","K50.919","R10.9","R10.84","M79.7","F17.210","G47.9","R00.0","R10.31","Z87.19","K21.9","Z79.899","Z88.8","Z91.19","K50.80","N91.2","R63.4","Z30.42","Z32.02","E27.40","Z23","Z30.013","R07.9","F33.9","R79.9","M53.3","N32.9","Z01.419","Z20.2","Z11.3","R53.83","H81.10","F31.9","F41.9","H91.90","F41.8","Z91.048","M79.671","E55.9","G47.30","M79.643","G25.81","G47.10","R06.83","R06.81","R10.11","R11.0","K50.10","R11.10","F41.1","R74.8","E87.6","K20.9","K29.70","K92.0","K29.60","K21.0","R79.89","R19.7","K92.2","K50.00","K25.3","K22.10","K44.9","K29.00","K52.9","R94.5","B37.81","F43.10","Z72.0","F43.12","F31.81","F90.2","Z30.09","R06.02","R40.0","Z71.3","Z68.26","D72.829","R50.9","R10.10","N94.6","R19.5","X58.XXXA","T18.4XXA","R31.9","R25.1","N39.3"],"date":["2020-06-25","2020-02-27","2021-07-19","2020-01-02","2021-11-03","2021-12-21","2020-02-27","2020-02-27","2020-03-09","2020-01-14","2021-05-06","2021-07-19","2021-07-19","2021-12-21","2021-07-20","2021-07-19","2021-12-21","2020-02-04","2020-02-04","2020-02-04","2021-12-21","2020-07-28","2020-03-12","2020-02-27","2020-03-09","2021-11-29","2020-05-14","2020-06-03","2021-09-21","2020-06-25","2020-10-07","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2021-01-04","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2021-07-22","2021-03-02","2021-01-08","2021-03-02","2021-03-02","2021-05-06","2021-12-21","2021-07-22","2021-11-29","2021-11-03","2021-09-21","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-12-21","2021-12-21","2019-06-15","2019-01-03","2019-08-05","2019-01-10","2019-06-15","2019-01-16","2019-01-15","2019-01-16","2019-01-15","2019-01-15","2019-01-15","2019-01-16","2019-01-15","2019-01-16","2019-01-15","2019-01-15","2019-01-15","2019-01-16","2019-01-17","2019-01-17","2019-02-13","2019-01-30","2019-02-05","2019-08-05","2019-08-05","2019-08-05","2019-09-03","2019-05-20","2019-10-09","2019-06-15","2019-06-15","2019-06-22","2019-06-22","2019-07-12","2019-10-09","2019-09-03","2019-09-23","2019-09-23","2019-10-23","2019-11-26","2019-12-20"],"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":[["","00591079501","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","51991001406","MELATONIN","TAB 3MG","90","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","54092019112","PENTASA","CAP 500MG CR","240","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","43598029590","PREGABALIN","CAP 150MG","60","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","5","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","62756052069","SUMATRIPTAN","TAB 25MG","9","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","60","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","10","Select","Select",""],["","00591079601","SULFASALAZIN","TAB 500MG","90","Select","Select",""],["","75834002012","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","00591505210","PREDNISONE","TAB 5MG","90","Select","Select",""],["","37000040514","METAMUCIL","CAP 0.52GM","60","Select","Select",""],["","66689002316","HYDROCO\/APAP","SOL 7.5-325","500","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","64980012950","FLORANEX","TAB ","50","Select","Select",""],["","00363011916","WAL-MUCIL","CAP 0.52GM","160","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","00071101668","LYRICA","CAP 150MG","10","Select","Select",""],["","42806016101","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","64764030020","ENTYVIO","INJ 300MG","1","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","13","Select","Select",""],["","43547038103","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68462024901","RANITIDINE","TAB 300MG","30","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","90","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","10572030201","PEG-3350\/KCL","SOL \/SODIUM","4,000.00","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","6","Select","Select",""],["","51672302002","LIDOCAINE","OIN 0.05","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","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":""}]}]}