{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LLOYD L BROWN","gend":0,"add":"217 COACHMAN DR","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1952-10-22","age":"","mstatus":"","insh":"900032731*01","cliId":"","pno":"757\/470-8066","cno":"757\/470-8066, ","email":"","ename":"","eno":"","pphy":"MANSER, THOMAS MD","ppno":"757\/446-8920","pcpadd":"825 FAIRFAX AVE SUITE 445","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":100073,"pcpname":"EVMS Internal Medicine","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K50.012","K43.2","I10.","K50.10","K50.00","Z00.00","Z13.31","F17.200","Z82.49","E11.9","E27.8","K50.90","K62.89","Z72.0","E53.8","E55.9","R06.00","R06.02","R06.09","R05.","R94.2","F17.210","K44.9","E78.5","Z23.","Z87.891","K50.919","R13.10","R68.89","R06.2","Z20.822","K57.30","K50.911","K64.8","F14.10","I16.9","K80.20","K62.5","R07.9","N52.9","K46.9","J44.9","K43.5","Z87.19","Z79.52","Z79.899","Z98.0","T78.40XA","R11.2"],"date":["2021-06-11","2021-06-17","2021-05-25","2021-06-11","2020-08-04","2020-08-12","2021-05-25","2021-05-25","2020-08-12","2020-08-12","2020-08-12","2021-05-25","2020-10-13","2020-11-10","2021-04-19","2021-05-25","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-06-11","2021-01-22","2021-05-25","2021-05-25","2020-08-12","2020-08-27","2021-04-19","2021-02-11","2021-02-11","2021-02-11","2020-07-14","2020-10-09","2020-10-09","2020-02-19","2020-02-19","2020-08-27","2020-10-09","2021-02-11","2021-03-15","2021-03-15","2021-03-15","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2020-11-10","2020-11-10"],"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":[["","31722082030","ARIPIPRAZOLE ","5MG","-7","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","-90","Select","Select",""],["","00054418125","DEXAMETHASON ","1MG","-3","Select","Select",""],["","50742011601","DESIPRAMINE ","100MG","-14","Select","Select",""],["","57894005427","STELARA ","5MG\/ML","104","Select","Select",""],["","54092019112","PENTASA ","500MG CR","240","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","00574709012","HYDROCORT ","25MG","48","Select","Select",""],["","60219107601","AZATHIOPRINE ","50MG","360","Select","Select",""],["","59779044870","CVS ","21MG\/24H","30","Select","Select",""],["","17478071130","LIDOCAINE ","2% JELLY","60","Select","Select",""],["","00378064110","PREDNISONE ","10MG","43","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","11917017096","VITAMIN ","2000UNIT","90","Select","Select",""],["","59088077120","LIDOCAINE\/HC ","3%-1%","1","Select","Select",""],["","00006430502","RENFLEXIS ","100MG","-5","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","90","Select","Select",""],["","08373747800","OPTICHAMBER ","DIAMOND","1","Select","Select",""],["","11917013368","B-12 ","2000MCG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","8","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","00378166093","SILDENAFIL ","100MG","-5","Select","Select",""],["","43598057530","TADALAFIL ","5MG","5","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","-30","Select","Select",""],["","00378718505","METFORMIN ","500MG","-60","Select","Select",""],["","00093356026","PEG\/NASUL,C ","NACL\/POT","-1","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4000","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":""}]}]}