{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA   A MCINNIS","gend":1,"add":"900 COUNTY ST APT 109","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1946-07-13","age":"","mstatus":"","insh":"900030467*01","cliId":"6MM9N45CC48","pno":"757\/393-0367","cno":"757\/393-0367","email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E05.90","I73.9","R94.4","D72.829","D64.9","I65.23","M79.605","N18.9","J44.9","R10.9","E66.9","I50.22","I42.9","Z01.810","I20.9","Z93.3","J30.9","I50.40","I10.","B35.1","L84.","M54.12","Z79.891","D72.820","I70.721","I97.418","D62.","E78.5","E78.00","F17.210","R00.0","Z86.14","Z86.010","Z85.41","Z90.710","Z79.02","Z79.82","Z79.83","Z79.51","L30.4","I51.89","R30.0","H93.A2","G89.4","C91.Z0","M85.80","H57.89","F17.200","Z23.","K59.00","I11.9","Z48.812","I11.0","I50.32","F32.9","E03.9","E55.9","K21.9","E04.2","N17.9","I70.321","Z87.891","Z91.81","R20.0","M79.606","E88.09","Z00.00","Z13.31","I87.2","Z95.820","I42.0","I70.203","I65.21","R14.0","D64.89","M10.9","K92.2","R31.9","R94.31","N39.0","R11.2","M79.661","R22.41","T82.856A","I70.8","I27.20","H04.123","M81.0","M54.5","M48.02","R60.0","M25.559","M25.552","I71.4","L76.22","I70.791","Z43.3","E87.8","E53.8","K30.","Z66.","B00.9","R39.15","H91.91","Z13.1","N18.30","H43.399","R06.00"],"date":["2021-10-08","2021-05-26","2020-09-09","2021-02-10","2021-02-03","2021-05-26","2021-05-20","2021-06-09","2021-09-29","2021-06-09","2021-06-30","2021-06-30","2021-06-09","2021-06-09","2021-06-30","2021-10-02","2020-05-15","2021-10-08","2021-10-08","2020-07-20","2020-02-24","2021-08-30","2020-09-16","2021-04-01","2020-10-21","2020-10-21","2020-10-27","2021-08-30","2020-10-27","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-12-07","2020-10-21","2020-10-21","2020-11-27","2021-02-10","2021-06-01","2021-06-21","2021-08-30","2021-06-21","2020-02-11","2020-02-11","2020-02-11","2020-09-10","2021-05-10","2021-06-30","2020-12-07","2020-12-07","2020-12-07","2021-09-29","2020-12-07","2020-12-07","2021-06-01","2021-05-14","2021-05-14","2020-10-21","2020-11-14","2020-11-14","2021-05-20","2021-05-14","2020-05-27","2021-06-21","2021-06-21","2020-10-12","2020-10-12","2020-05-04","2020-05-26","2021-05-26","2020-09-09","2020-11-03","2020-11-03","2020-11-03","2021-04-01","2021-04-30","2021-05-04","2021-05-04","2021-05-20","2021-05-20","2021-05-26","2021-05-26","2021-06-21","2020-02-14","2021-07-08","2020-07-17","2021-08-30","2020-07-15","2020-07-17","2020-09-16","2020-10-25","2020-10-21","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-04-01","2021-04-01","2021-06-08","2021-07-08","2021-09-29","2021-08-30","2021-10-08"],"priorHcc":[null,"","","","","","","",null,"","","","","","",null,"",null,null,"","",null,"","","","","",null,"","","","","","","","","","","","","","","",null,"","","","","","","","","","",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":[["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","90","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","28","Select","Select",""],["","65862001130","SERTRALINE ","25MG","90","Select","Select",""],["","60505258009","ATORVASTATIN ","40MG","135","Select","Select",""],["","51293082001","METHIMAZOLE ","5MG","90","Select","Select",""],["","55111019690","CLOPIDOGREL ","75MG","-30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","90","Select","Select",""],["","72511077001","REPATHA ","420\/3.5","4","Select","Select",""],["","50742061501","METOPROL ","25MG ER","270","Select","Select",""],["","11822331520","LORATADINE ","10MG","30","Select","Select",""],["","00173071720","ADVAIR ","230\/21","-12","Select","Select",""],["","00078065967","ENTRESTO ","24-26MG","-180","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","60","Select","Select",""],["","11822033209","ALLERGY ","25MG","2","Select","Select",""],["","16714063301","ALENDRONATE ","70MG","4","Select","Select",""],["","31722070090","LOSARTAN ","25MG","90","Select","Select",""],["","00186077760","BRILINTA ","90MG","-60","Select","Select",""],["","00378911293","NITROGLYCER ","0.4MG\/HR","30","Select","Select",""],["","11822454350","RA ","25MG","2","Select","Select",""],["","00054001925","PREDNISONE ","50MG","3","Select","Select",""],["","29033000301","SUCRALFATE ","1GM","90","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","45802005935","NYSTATIN ","100000","-15","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00527512570","LACTULOSE ","10GM\/15","237","Select","Select",""],["","16714065202","CIPROFLOXACN ","500MG","-8","Select","Select",""],["","72140045231","AQUAPHOR ","","50","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","ALBUTER","180","Select","Select",""],["","00378427677","VALACYCLOVIR ","1GM","14","Select","Select",""],["","00781543820","CEFPODOXIME ","100MG","20","Select","Select",""],["","68001024617","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","21922000909","DICLOFENAC ","1%","100","Select","Select",""],["","37000040511","METAMUCIL ","0.36GM","160","Select","Select",""],["","71351001250","LACTOBACILLU ","","50","Select","Select",""],["","68382077306","EZETIMIBE","10MG","-90","Select","Select",""],["","68382077306","","10MG","90","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","72511077001","REPATHA","420\/3.5","4","Select","Select",""],["","42858010301","OXYCOD\/APAP","7.5-325","-120","Select","Select",""],["","51293082001","METHIMAZOLE","5MG","-90","Select","Select",""],["","55111019690","CLOPIDOGREL","75MG","30","Select","Select",""],["","60505258009","ATORVASTATIN","40MG","135","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","90","Select","Select",""],["","65862001130","SERTRALINE","25MG","90","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","90","Select","Select",""],["","11822331520","LORATADINE","10MG","30","Select","Select",""],["","00078065967","ENTRESTO","24-26MG","60","Select","Select",""],["","50742061501","METOPROL","25MG ER","270","Select","Select",""],["","16714063301","ALENDRONATE","70MG","4","Select","Select",""],["","11822033209","ALLERGY","25MG","2","Select","Select",""],["","00054001925","PREDNISONE","50MG","3","Select","Select",""],["","00173071720","ADVAIR","230\/21","12","Select","Select",""],["","43547028910","BUPROPION","150MG SR","60","Select","Select",""],["","00378911293","NITROGLYCER","0.4MG\/HR","90","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00186077760","BRILINTA","90MG","60","Select","Select",""],["","76204060060","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","16714065202","CIPROFLOXACN","500MG","8","Select","Select",""],["","59762040105","SUCRALFATE","1GM","112","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","72140045231","AQUAPHOR","","50","Select","Select",""],["","45802005935","NYSTATIN","100000","15","Select","Select",""],["","11822454350","RA","25MG","2","Select","Select",""],["","31722070090","LOSARTAN","25MG","30","Select","Select",""],["","00527512570","LACTULOSE","10GM\/15","237","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","00378427677","VALACYCLOVIR","1GM","14","Select","Select",""],["","68001024617","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00781543820","CEFPODOXIME","100MG","20","Select","Select",""],["","21922000909","DICLOFENAC","1%","100","Select","Select",""],["","71351001250","LACTOBACILLU","","50","Select","Select",""],["","37000040511","METAMUCIL","0.36GM","160","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","Select","Select",""],["","70461012103","FLUAD ","INJ 2021-22","0","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","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}