{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOE   L DAVIS","gend":0,"add":"1811 LASALLE AVE","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1947-05-24","age":"","mstatus":"","insh":"900031116*01","cliId":"2H29E83EF45","pno":"757\/672-8586","cno":"757\/672-8586","email":"","ename":"","eno":"","pphy":"OHANIAN, KARO G MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":100340,"pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"757\/816-0163","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R91.8","R04.2","F17.200","J43.9","I71.4","I74.09","I72.3","I70.0","I70.8","I77.4","G25.81","M51.36","J84.10","J44.9","Z68.22","C34.31","J90.","J81.1","I08.3","R06.02","C34.91","J18.9","J96.21","J91.0","I25.10","G89.29","N40.0","Z51.5","F41.9","I10.","E78.5","I25.2","Z87.891","Z79.899","Z87.01","Z79.82","J18.1","Z85.118","Z01.818","G58.9","I21.9","M50.30","M51.37","M79.2","C34.90","F11.20","Z51.12","S19.9XXA","S00.03XA","R07.81","T14.90XA","A41.9","Z68.23","D72.829","J43.8","Z51.11","Z00.00","Z13.31","J98.4","Z98.890","R59.0","R10.9","R07.9","M54.9","M47.817","M19.019","M23.239","Z79.891","F19.20","I51.7","R94.31","Z01.810","E78.2","Z20.828","S09.90XA","S20.212A","M47.812","Z86.79","V89.2XXA","Y93.89","Y92.411","R07.1","R09.02","Z99.81","M46.1","I21.4","J98.11","R63.4","M51.34","R33.9","Z01.812","M51.9","M19.041","M19.042","M54.17","M19.90","S83.209A","R04.0","R59.1","C77.1","C80.1","J96.01","J96.11","Z95.828","R91.1","Z23.","J44.1","J44.0","F17.210","Z95.5","Z71.89","R59.9","R60.1","I49.1","I49.3","M54.16","S39.012A","S16.1XXA","M48.061","R53.81","R54.","R52.","M54.5","M54.2","M12.88","C79.51","Z51.0","C79.9","G89.3","M85.80","J34.2","Z20.822","R65.20","C79.31","M84.48XA","M47.816","M99.71","D18.09","M51.24","K86.9","E27.8","M48.56XA","M84.58XA","D64.9","M89.8X8","Z71.6","Z72.0","N42.9","M89.9","D63.0","R74.8","E53.8","I11.0"],"date":["2020-12-18","2020-12-16","2021-11-15","2021-08-31","2021-09-23","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2021-04-09","2021-07-30","2020-11-14","2021-09-15","2020-11-26","2021-10-22","2021-03-05","2020-11-12","2020-11-14","2020-12-21","2021-09-17","2021-08-31","2021-09-05","2020-11-21","2021-09-29","2020-11-21","2021-08-23","2021-08-24","2020-11-21","2021-09-29","2020-11-21","2020-11-21","2020-12-31","2020-11-21","2020-11-21","2020-11-21","2020-12-18","2021-09-10","2021-03-05","2021-04-09","2021-07-30","2021-07-30","2021-07-16","2021-06-02","2021-11-15","2021-08-10","2021-07-08","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-09-05","2020-11-26","2021-08-23","2020-11-26","2021-10-15","2021-08-05","2021-08-05","2021-03-05","2021-05-11","2020-10-23","2020-11-22","2021-08-31","2021-08-23","2021-07-09","2021-03-01","2021-03-01","2021-08-10","2021-08-10","2020-09-23","2020-09-23","2020-09-23","2021-09-29","2020-11-12","2021-05-11","2021-05-11","2021-08-28","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2020-11-22","2021-08-31","2021-08-23","2021-06-23","2020-04-27","2020-06-01","2020-10-13","2020-10-16","2021-03-05","2021-03-05","2021-08-10","2020-02-18","2020-02-18","2021-08-10","2020-02-18","2020-02-18","2020-06-01","2020-10-13","2020-10-13","2021-09-01","2020-11-14","2021-09-03","2021-08-17","2020-08-07","2020-08-07","2020-11-12","2020-11-12","2021-08-31","2021-08-23","2021-08-24","2020-12-16","2020-12-16","2020-12-21","2020-12-21","2021-08-10","2021-06-02","2021-06-02","2021-07-09","2021-08-31","2021-08-24","2021-08-24","2021-08-29","2021-07-30","2021-07-30","2021-09-10","2021-09-07","2021-08-29","2021-09-03","2021-09-01","2021-08-03","2021-08-31","2021-09-03","2021-08-31","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-08-22","2021-08-22","2021-08-27","2021-08-24","2021-08-27","2021-08-19","2021-08-22","2021-08-22","2021-08-31","2021-08-19","2021-08-23","2021-08-31","2021-09-24","2021-09-29"],"priorHcc":["","",null,null,null,"","","","","","","","",null,"",null,"","","","",null,null,null,"",null,"",null,"","",null,"","","","","","","",null,"","","","","","",null,"","","","","","",null,"",null,"",null,"","","","","","",null,null,"","","","","","","","",null,"","","",null,"","","","","",null,null,"","","","","","","","","","","","","","","","",null,"",null,"","","","","",null,null,"","","","","","","","","",null,"","",null,"","",null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,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":[["","60505708202","FENTANYL ","50MCG\/HR","10","Select","Select",""],["","00406012501","HYDROCO\/APAP ","10-325MG","60","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","52817036010","METOPROL ","25MG","26","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","62332003031","ROPINIROLE ","0.25MG","90","Select","Select",""],["","68382013616","LOSARTAN ","50MG","-30","Select","Select",""],["","33342002332","LEVOFLOXACIN ","750MG","4","Select","Select",""],["","00527293441","PREDNISONE ","20MG","8","Select","Select",""],["","00093506101","HYDROXYZ ","25MG","90","Select","Select",""],["","57237007810","ONDANSETRON ","8MG ODT","45","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","30","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","60","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","00713053612","PROMETHEGAN ","12.5MG","12","Select","Select",""],["","00597016061","SPIRIVA ","1.25MCG","4","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","0","","","480","Select","Select",""],["","069315090401","LORAZEPAM ","0.5MG","2","Select","Select",""],["","059762444002","METHYLPRED ","4MG","21","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","60","Select","Select",""],["","43598075260","BUPROPION ","150MG SR","173","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","36","Select","Select",""],["","00406905076","FENTANYL","50MCG\/HR","-10","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","30","Select","Select",""],["","00406012501","HYDROCO\/APAP","10-325MG","60","Select","Select",""],["","68382013516","LOSARTAN","25MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","52817036010","METOPROL","25MG","26","Select","Select",""],["","62332003031","ROPINIROLE","0.25MG","90","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","00093506101","HYDROXYZ","25MG","-90","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","45","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","30","Select","Select",""],["","00597016061","SPIRIVA","1.25MCG","4","Select","Select",""],["","00713053612","PROMETHEGAN","12.5MG","12","Select","Select",""],["","33342002332","LEVOFLOXACIN","750MG","4","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","60","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","43598075260","BUPROPION","150MG SR","173","Select","Select",""],["","69315090401","LORAZEPAM","0.5MG","2","Select","Select",""],["","00406052201","OXYCOD\/APAP","7.5-325","100","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","60","Select","Select",""],["","51991074790","DULOXETINE","30MG","30","Select","Select",""],["","00904693181","PEG","","30","Select","Select",""],["","69315012710","FOLIC","1000MCG","50","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","90","Select","Select",""],["","00527293441","PREDNISONE","20MG","8","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","57896055510","SENNA-PLUS","8.6-50MG","60","Select","Select",""],["","00904693181","PEG ","POW ","30","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","50","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","57896055510","SENNA-PLUS ","TAB 8.6-50MG","60","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}