{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAZEL   E CONANT","gend":1,"add":"3321 LENS AVE APT A","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1930-10-09","age":"","mstatus":"","insh":"900032020*01","cliId":"5XK4A37JN07","pno":"757\/853-5312","cno":"757\/853-5312","email":"","ename":"","eno":"","pphy":"GRANT JR, THOMAS R MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE STE 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":["I73.9","E78.5","I10.","I65.29","R00.0","Z00.00","Z74.09","Z78.9","S32.010A","E11.51","E78.00","I95.1","Z86.718","Z86.73","Z87.891","Z90.710","Z79.82","Z79.02","Z79.899","Z82.49","H04.123","Z20.828","M25.559","E11.9","S32.010D","S32.019A","L21.9","M48.56XD","M51.36","M16.0","Z91.81","H10.523","M54.5","G89.29","E55.9","I87.2","S32.018S","G62.9","R42.","I35.0","I70.213","I65.23","I74.09","R60.0","N30.00","W19.XXXA","H35.033","K59.00","R10.13","R10.9","S39.91XA","H02.054","R25.2","R68.89","H16.223","H26.493","H43.813","H35.363","H02.822","D23.121","E11.3291","H02.135","H02.055","H35.431"],"date":["2021-05-26","2020-10-12","2021-05-18","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-02-19","2020-03-23","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-08-07","2020-02-14","2020-03-23","2020-02-14","2020-02-14","2020-02-14","2021-01-11","2021-04-24","2020-02-08","2021-08-26","2020-02-19","2020-02-19","2020-08-07","2020-03-23","2020-03-23","2020-03-23","2021-01-06","2020-11-12","2021-01-06","2021-01-06","2021-01-06","2021-01-29","2021-01-29","2021-01-29","2021-05-18","2021-05-18","2021-11-10","2021-05-26","2021-11-10","2020-01-13","2020-02-08","2020-02-08","2021-09-24","2020-03-02","2020-03-02","2020-02-14","2020-02-14","2021-08-26","2021-08-24","2021-08-24","2021-09-24","2021-09-24","2021-08-26","2021-09-24","2021-08-26","2021-08-26","2021-09-24","2021-09-24","2021-09-24","2021-09-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","",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":[["","00093206406","CILOSTAZOL ","100MG","180","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","-14","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","60","Select","Select",""],["","68180051202","LISINOPRIL ","2.5MG","90","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60","Select","Select",""],["","00363056314","ASPIRIN ","81MG EC","90","Select","Select",""],["","11917007602","ACID ","20MG","60","Select","Select",""],["","00363078522","SENNA-S ","8.6-50MG","108","Select","Select",""],["","55111012405","ATORVASTATIN ","80MG","90","Select","Select",""],["","10702001850","OXYCODONE ","5MG","20","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","-120","Select","Select",""],["","00574402235","BACITRACIN ","OP","4","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","11917005028","CALCIUM ","600MG","90","Select","Select",""],["","31604002585","VITAMIN ","2000UNIT","90","Select","Select",""],["","00023916360","RESTASIS ","0.05%","60","Select","Select",""],["","00037682315","PROCTOFOAM ","NS 1%","15","Select","Select",""],["","00054429731","","20MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","00363078522","SENNA-S","8.6-50MG","108","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","11917007602","ACID","20MG","60","Select","Select",""],["","00363056314","ASPIRIN","81MG EC","90","Select","Select",""],["","68180051202","LISINOPRIL","2.5MG","90","Select","Select",""],["","55111012405","ATORVASTATIN","80MG","90","Select","Select",""],["","00093206406","CILOSTAZOL","100MG","180","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","00574402235","BACITRACIN","OP","4","Select","Select",""],["","69097052444","DICLOFENAC","1%","-100","Select","Select",""],["","31604002585","VITAMIN","2000UNIT","90","Select","Select",""],["","11917005028","CALCIUM","600MG","90","Select","Select",""],["","10702001850","OXYCODONE","5MG","20","Select","Select",""],["","00023916360","RESTASIS","0.05%","180","Select","Select",""],["","00037682315","PROCTOFOAM","NS 1%","15","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","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","",""],["No","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":""}]}]}