{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY   A DAVIS","gend":1,"add":"7931 ORCHID AVE APT # 3","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1950-06-13","age":"","mstatus":"","insh":"900033293*01","cliId":"3KH1TU6DQ17","pno":"757\/230-0521","cno":"757\/230-0521","email":"","ename":"","eno":"","pphy":"CHAKAN, MATTHEW C MD","ppno":"757\/446-8920","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":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.15","Z00.00","D64.9","Z01.812","Z20.828","F41.1","G47.00","R06.83","I10.","D50.9","R45.89","Z13.31","Z87.891","Z23.","G47.10","G47.30","R35.1","E66.9","G25.81","M19.012","M17.0","J06.9","Z03.818","Z12.31","M25.561","M25.562","E66.09","Z68.33","D24.1","R92.1","M25.569","F34.1","M25.512","E55.9","F41.9","I25.10","H40.013","H04.123","E87.6","Z12.11","K57.30","H93.19","Z79.899","Z98.42","Z98.41","Z88.0","Z79.82","R53.83"],"date":["2020-06-24","2021-04-28","2020-06-29","2020-12-05","2020-12-05","2020-12-08","2021-04-28","2020-12-30","2021-04-28","2021-06-18","2021-04-28","2021-04-28","2021-04-28","2020-10-13","2020-10-02","2020-12-07","2021-04-28","2021-04-28","2021-04-28","2020-11-24","2021-04-28","2020-04-29","2020-04-29","2021-07-23","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2020-07-23","2020-07-23","2020-08-21","2020-11-17","2020-12-04","2021-04-28","2021-04-28","2021-04-28","2021-03-09","2021-03-09","2021-06-18","2020-12-10","2020-12-10","2021-06-03","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-12-07","2021-06-03"],"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":[["","29300013005","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","68382032010","POT  CHLORIDE","10MEQ ER","30","Select","Select",""],["","16729017317","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","68645055354","LISINOPRIL ","20MG","90","Select","Select",""],["","00093057610","LOVASTATIN ","20MG","90","Select","Select",""],["","72205000490","ROSUVASTATIN ","20MG","60","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","00832532411","POT  CL MICRO","10MEQ ER","30","Select","Select",""],["","58160082652","HAVRIX ","1440UNIT","1","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","30","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","0.1% OP","4","Select","Select",""],["","31604003175","","","30","Select","Select",""],["","65162067684","AZELASTINE ","0.10%","-30","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","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":""}]}]}