{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICHOLAS   J CHRISTOU","gend":0,"add":"9705 SEABREEZE ROAD","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1960-08-10","age":"","mstatus":"","insh":"900032917*01","cliId":"3JY4HP0KT82","pno":"757\/589-3288","cno":"757\/589-3288","email":"","ename":"","eno":"","pphy":"FLEMMER, MARK C MD","ppno":"757\/446-8910","pcpadd":"825 FAIRFAX AVE SUITE 445","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100073,"pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-7452","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J11.1","Z74.3","R06.02","J98.4","J18.9","J96.01","N39.0","R74.8","M17.12","G89.4","R10.9","G62.9","Z90.49","C92.00","K57.80","A41.89","U07.1","J12.89","I50.22","I11.0","E66.9","Z68.33","L27.0","T50.995A","F41.9","Z87.891","Z79.899","Z88.5","Z85.6","M19.90","M79.675","M25.50","E78.5","Z00.00","Z11.59","R00.0","Z20.828","A41.9","C92.01","R21.","Z12.11","Z12.12","Z79.891","K66.0","I10.","R50.9","R79.89","K44.9","R53.83","D64.9","M79.2","R05.","D84.9","M17.10","N52.9","G89.29","G62.0","T45.1X5A"],"date":["2020-06-28","2020-06-28","2020-06-29","2020-06-28","2020-07-04","2020-07-04","2020-06-29","2020-06-29","2021-06-14","2021-11-10","2021-10-18","2021-11-10","2021-05-13","2021-06-30","2020-05-14","2020-06-29","2020-07-04","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2021-10-18","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2021-03-29","2021-03-29","2021-03-10","2021-10-18","2021-06-02","2020-03-02","2020-06-28","2020-06-29","2020-06-30","2021-10-18","2020-06-29","2020-08-10","2020-08-10","2021-09-09","2021-04-13","2020-05-27","2020-06-29","2020-06-29","2020-06-29","2021-06-24","2021-07-13","2021-11-10","2021-08-02","2021-08-02","2021-10-18","2021-10-18","2021-10-18","2021-09-09","2021-09-09"],"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":[["","00406012505","HYDROCO\/APAP ","10-325MG","90","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","60","Select","Select",""],["","00378395005","ATORVASTATIN ","10MG","90","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90","Select","Select",""],["","65862014305","CARVEDILOL ","6.25MG","-180","Select","Select",""],["","00378064110","PREDNISONE ","10MG","55","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","68382091634","METHYLPRED ","4MG","21","Select","Select",""],["","65862041901","SMZ-TMP ","400-80MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","051672400101","NORTRIPTYLIN ","10MG","60","Select","Select",""],["","042806071401","BENZONATATE ","100MG","42","Select","Select",""],["","023155013525","DOXYCYC ","100MG","20","Select","Select",""],["","00406012505","","10-325MG","90","Select","Select",""],["","00406012505","HYDROCO\/APAP","10-325MG","90","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","60","Select","Select",""],["","65862014305","CARVEDILOL","6.25MG","-180","Select","Select",""],["","00378395005","ATORVASTATIN","10MG","90","Select","Select",""],["","65162010250","GABAPENTIN","300MG","90","Select","Select",""],["","00378064110","PREDNISONE","10MG","55","Select","Select",""],["","65862041901","SMZ-TMP","400-80MG","14","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","23155013525","DOXYCYC","100MG","20","Select","Select",""],["","42806071401","BENZONATATE","100MG","42","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","51672400101","NORTRIPTYLIN","10MG","60","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","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":""}]}]}