{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE   C PERRY","gend":1,"add":"1921 ROBERT HALL BLVD APT 7304","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1947-10-12","age":"","mstatus":"","insh":"900030871*01","cliId":"1HH5RE5DP85","pno":"757\/288-6041","cno":"757\/288-6041","email":"","ename":"","eno":"","pphy":"LAYNE, MICHAEL 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":["N18.3","N25.81","E11.9","H25.13","Z01.818","H26.9","E11.65","I10.","E78.5","H25.812","Z98.41","Z98.42","H40.013","R68.84","N18.30","H61.23","H90.3","R22.1","Z23.","I12.9","R80.9","Z96.1","H25.811","H25.11","K64.8","Z86.010","Z12.11","K64.1","K57.30","Z00.00","Z13.31","E11.22","N18.32","Z20.828","Z12.31","H25.12","Z01.811","R92.0","R92.8","M79.606","M25.512"],"date":["2020-06-30","2021-04-06","2021-08-10","2020-05-04","2020-05-19","2020-05-13","2021-08-10","2021-01-06","2020-05-05","2020-05-13","2020-09-11","2020-09-11","2020-10-21","2020-10-15","2021-01-06","2021-03-05","2021-03-05","2021-03-05","2021-03-27","2021-04-13","2021-04-13","2020-10-21","2020-05-14","2020-05-21","2021-02-10","2021-03-16","2021-02-10","2021-03-16","2021-03-16","2021-01-06","2021-01-06","2021-04-13","2021-04-13","2020-07-06","2020-10-13","2020-05-11","2020-05-11","2020-10-16","2020-10-16","2021-08-10","2021-08-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","64380080438","RANITIDINE ","300MG","-90","Select","Select",""],["","62332002830","LOSARTAN ","50MG","-90","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","90","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","90","Select","Select",""],["","00065924007","DUREZOL ","0.05%","5","Select","Select",""],["","60505100301","KETOROLAC ","0.50%","5","Select","Select",""],["","00023932105","ALPHAGAN ","0.10%","-30","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","-1","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0","Select","Select",""],["","00115169449","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00574709012","HYDROCORT ","25MG","14","Select","Select",""],["","70645002525","CAPSAICIN ","0.03%","25","Select","Select",""],["","64380080438","","300MG","-90","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}