{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WINTON   L HENDRICKS JR","gend":0,"add":"2731 JASON AVE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1953-05-13","age":"","mstatus":"","insh":"900034491*01","cliId":"2WK4MU0UX74","pno":"757\/627-7744","cno":"757\/627-7744","email":"","ename":"","eno":"","pphy":"KING, JODY P MD","ppno":"757\/446-8920","pcpadd":"SUITE 445 825 FAIRFAX AVENUE","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":"757\/515-5358","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5242","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","M48.02","Z98.1","E29.1","H40.1121","H25.11","Z23.","A41.51","N13.6","N17.9","M33.20","N18.3","Z21.","K21.9","E78.00","M54.16","I12.9","F32.9","E78.5","R65.20","K59.00","Z88.5","Z87.440","A41.50","N39.0","R78.81","N13.2","N20.0","S22.42XD","A41.9","N30.00","R50.9","R68.89","N20.1","R74.8","Z51.81","M62.81","I51.89","Z01.810","Z12.11","F33.1","F90.0","Z00.00","K31.84","Z13.31","N18.2","D75.1","E55.9","E78.1","M54.12","R29.898","M62.521","R53.1","G47.9","Z98.890","H26.9","Z12.5","N12.","N20.2","M47.12","M54.2","M19.011","M47.22","N18.30","D48.5","Z13.820","A41.81","R53.83","I10.","B35.1","E83.52","L82.0","R23.8","L29.9","R58.","L57.0","S32.502D","M25.541","M43.12","R50.81","D89.9","B37.9","B95.2","R07.9","Z01.818","M62.50","F34.1","B19.10","M25.78","Z88.1","Z88.8","Z86.010","Z79.899","Z79.82","Z79.52","G95.9","M50.11","M50.01","R79.89","D12.6","Z01.812","Z20.822","M48.062","N19.","M50.13","R11.2","Z11.1","Z11.3","V89.2XXD","J30.2","I73.9","F41.9","N40.0","Z87.19","Z87.442","N25.89","R91.8","R39.9","I25.9","R35.1","G47.10","L08.9","H43.811","H02.423","N52.1","N28.1","H43.813","G95.89","M48.061","K29.60","R41.0","S61.219A","K62.82","R41.3","H26.491","S06.6X9S","N48.6"],"date":["2021-10-11","2021-05-10","2021-02-10","2021-06-22","2021-03-04","2021-04-28","2021-10-11","2020-03-08","2020-03-08","2020-03-09","2021-09-30","2020-04-21","2020-10-23","2021-04-13","2021-08-24","2020-03-08","2020-04-21","2020-08-04","2021-06-22","2020-03-08","2020-03-08","2020-08-04","2020-04-10","2020-03-11","2021-10-19","2020-03-11","2020-03-11","2021-10-19","2020-04-10","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-13","2021-09-30","2020-09-02","2021-09-30","2020-07-17","2020-07-17","2020-07-23","2021-11-16","2021-11-16","2020-09-16","2020-10-23","2020-09-16","2021-08-26","2020-09-16","2021-06-22","2020-09-16","2021-07-22","2021-03-01","2021-03-01","2021-01-04","2021-01-04","2021-01-04","2021-04-28","2021-04-13","2020-03-11","2020-04-10","2021-05-10","2020-08-04","2020-08-07","2021-05-10","2021-11-04","2021-03-16","2020-03-04","2020-04-28","2021-10-11","2021-11-04","2020-09-24","2020-10-14","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2020-01-13","2020-01-13","2020-02-24","2020-04-10","2020-04-14","2020-04-14","2020-04-14","2021-08-24","2020-07-23","2020-07-23","2021-08-26","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-11-09","2020-08-25","2020-08-25","2021-04-13","2021-04-13","2021-04-26","2021-04-26","2021-09-30","2020-04-10","2020-06-13","2020-07-21","2020-07-30","2021-10-11","2020-07-27","2020-04-10","2020-04-10","2020-04-10","2021-10-19","2020-04-10","2020-04-10","2020-04-21","2020-08-07","2020-12-17","2020-04-09","2020-10-14","2021-07-22","2021-01-26","2021-03-04","2021-03-04","2021-10-19","2021-04-13","2020-03-02","2020-06-13","2020-06-15","2020-10-23","2021-07-22","2021-06-10","2021-08-24","2021-11-04","2021-08-27","2021-11-04","2021-10-19"],"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]}},{"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":[["","67877019705","AMLODIPINE ","2.5MG","90","Select","Select",""],["","51991074710","DULOXETINE ","30MG","90","Select","Select",""],["","49702023113","TRIUMEQ ","","30","Select","Select",""],["","60219107601","AZATHIOPRINE ","50MG","60","Select","Select",""],["","68180094311","TESTOSTERONE ","30MG\/ACT","-90","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","20","Select","Select",""],["","31722070490","VALACYCLOVIR ","500MG","180","Select","Select",""],["","00054472831","PREDNISONE ","5MG","180","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","-30","Select","Select",""],["","00172541346","FLUCONAZOLE ","200MG","-7","Select","Select",""],["","16729004517","ATORVASTATIN ","20MG","60","Select","Select",""],["","13668042905","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00023320503","LUMIGAN ","0.01%","2","Select","Select",""],["","55111012705","CIPROFLOXACN ","500MG","19","Select","Select",""],["","31722059690","FENOFIBRATE ","145MG","90","Select","Select",""],["","00093227534","AMOX\/K ","875-125","28","Select","Select",""],["","43547040010","CYCLOBENZAPR ","10MG","40","Select","Select",""],["","42858010450","OXYCOD\/APAP ","10-325MG","60","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","81","Select","Select",""],["","76385012350","METHOCARBAM ","500MG","90","Select","Select",""],["","16714066302","GABAPENTIN ","400MG","90","Select","Select",""],["","61958250101","BIKTARVY ","","30","Select","Select",""],["","51672208002","TERBINAFINE ","1%","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","57237023305","SMZ-TMP ","800-160","28","Select","Select",""],["","052268020101","SUTAB ","","24","Select","Select",""],["","016729047801","METHYLPHENID ","5MG","60","Select","Select",""],["","61314012605","KETOROLAC ","0.50%","5","Select","Select",""],["","51991074710","","30MG","90","Select","Select",""],["","51991074710","DULOXETINE","30MG","90","Select","Select",""],["","60219107601","AZATHIOPRINE","50MG","60","Select","Select",""],["","65162047810","NITROFURANTN","100MG","20","Select","Select",""],["","49702023113","TRIUMEQ","","30","Select","Select",""],["","45802061001","TESTOSTERONE","30MG\/ACT","90","Select","Select",""],["","00054472831","PREDNISONE","5MG","180","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","14","Select","Select",""],["","31722070490","VALACYCLOVIR","500MG","180","Select","Select",""],["","69097094505","ATORVASTATIN","20MG","60","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","00172541346","FLUCONAZOLE","200MG","7","Select","Select",""],["","13668042905","PANTOPRAZOLE","40MG","90","Select","Select",""],["","67877019710","AMLODIPINE","2.5MG","90","Select","Select",""],["","00093227534","AMOX\/K","875-125","28","Select","Select",""],["","43547040010","CYCLOBENZAPR","10MG","-40","Select","Select",""],["","31722059690","FENOFIBRATE","145MG","90","Select","Select",""],["","76385012350","METHOCARBAM","500MG","90","Select","Select",""],["","55111018015","TIZANIDINE","4MG","-81","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","16714066302","GABAPENTIN","400MG","90","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","31722094905","OXYCOD\/APAP","5-325MG","36","Select","Select",""],["","51672208002","TERBINAFINE","1%","30","Select","Select",""],["","57237023305","SMZ-TMP","800-160","28","Select","Select",""],["","00023320503","LUMIGAN","0.01%","2","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","16729047801","METHYLPHENID","5MG","60","Select","Select",""],["","55566670001","CLENPIQ ","SOL ","-1","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","",""],["Yes","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":""}]}]}