{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CASSANDRA THOMPSON","gend":1,"add":"3   DALE DRIVE                                              ","city":"PORTSMOUTH                    ","state":"VA","zip":"23704-5308","dob":"1987-09-05","age":"","mstatus":"","insh":10179695,"cliId":"","pno":7576105760,"cno":7576105760,"email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA A                                            ","ppno":"","pcpadd":"1701 High St,Ste K","pcpcity":"Portsmouth                    ","pcpstate":"VA","pcpzip":237043103,"pcpcounty":"","pcpid":"P9058629","pcpname":"EVMS MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3   DALE DRIVE                                              ","madd2":"                                                            ","madd3":"","mcity":"PORTSMOUTH                    ","mstate":"VA","mzip":"23704-5308","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O09.892","O09.90","Z20.2","O35.9XX0","Z36.86","O09.219","Z3A.20","Z3A.22","O09.92","O26.879","R51","Z3A.23","O26.899","R35.0","Z3A.00","O99.89","R10.30","Z3A.24","R00.2","Z39.1","Z34.82","Z34.83","O34.211","O82","O99.355","G89.18","O99.824","Z37.0","Z3A.39","Z79.899","Z88.0","Z23","Z91.040","Z01.818","O34.219","P22.9","O14.15","O90.0","G44.209","Z87.891","O14.95","R10.84","T14.8XXA","Z98.891","I10","G44.201","G44.53","Z01.419","N92.1","Z39.2","Z30.09","M79.10","Y04.8XXA","R22.0","S09.90XA","M54.9","Y09","W19.XXXA","E66.9","R40.2142","R40.2252","R40.2362","Z32.01","O46.90","O20.9","O26.891","R10.2","O46.91","O20.8","Z3A.01","O21.0","E86.0","N30.00","O21.1","O99.891","R11.0","O23.11","O34.11","D25.9","R10.9","O36.80X0","Z3A.09","Z32.00","O02.1","O03.4","F43.10","Z01.89","J45.909","E66.3","Z91.410","F41.1","R51.9"],"date":["2019-05-16","2019-05-20","2019-05-16","2019-06-12","2019-06-03","2019-06-12","2019-05-16","2019-06-05","2019-06-05","2019-06-12","2019-12-07","2019-06-12","2019-06-24","2019-06-24","2021-05-16","2019-06-24","2019-06-24","2019-06-24","2019-09-20","2019-09-25","2019-09-25","2019-09-25","2019-09-27","2019-09-26","2019-09-26","2019-09-28","2019-09-26","2019-09-27","2019-09-27","2021-05-16","2021-05-16","2019-09-26","2021-05-25","2019-09-26","2019-09-27","2019-09-27","2019-10-02","2019-10-02","2019-10-02","2021-05-25","2019-10-04","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-03","2019-10-04","2019-12-05","2019-12-05","2019-12-05","2021-08-30","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2021-06-09","2021-05-25","2021-06-09","2021-05-16","2021-05-16","2021-05-25","2021-05-17","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-06-09","2021-06-09","2021-06-11","2021-06-14","2021-06-14","2021-11-01","2021-08-30","2021-11-01","2021-08-30","2021-07-01","2021-11-01","2021-11-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"",null,"",null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68462030529","NORETHINDRON","0.35MG","28","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","28","Select","Select",""],["","55111015330","ONDANSETRON","4MG","14","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","20","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","21","Select","Select",""],["","65162046650","IBUPROFEN","800MG","12","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","28","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00904759080","FEROSUL","325MG","15","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","16714036004","MONO-LINYAH","0.25-35","28","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","43386016006","MISOPROSTOL","100MCG","8","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","14","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","00093310953","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","12","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","31722099601","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","15","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","16714036004","MONO-LINYAH ","TAB 0.25-35","28","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","43386016006","MISOPROSTOL ","TAB 100MCG","8","Select","Select",""],["","43547034703","PAROXETINE ","TAB 10MG","30","Select","Select",""],["","70010013901","NAPROXEN ","TAB 500MG","60","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}