{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CHRISTINA HALDIMAN","gend":1,"add":"9646 SELBY PL APT B","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1984-10-16","age":"","mstatus":"","insh":"900035232*01","cliId":"","pno":"757\/670-5083","cno":"757\/670-5083, ","email":"","ename":"","eno":"","pphy":"SHIPLEY, KATHERINE N PA","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family 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":["F33.1","F41.9","F98.8","T86.91","Z94.4","K51.919","T86.41","M85.80","Z01.419","Z30.9","R87.619","Z12.4","R10.32","K74.0","R94.5","I10.","Z00.00","K75.4","K51.90","Z13.31","F32.9","K42.9","T86.49","R79.89"],"date":["2021-01-28","2021-01-28","2021-01-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2020-05-13","2020-06-25","2020-04-22","2020-06-25","2020-06-25","2021-04-28","2020-01-02","2020-01-02","2020-01-02","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-11-10","2020-01-02","2020-08-07"],"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":[["","00054429731","FUROSEMIDE ","20MG","45","Select","Select",""],["","63304061650","DOXYCYC ","100MG","50","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","-60","Select","Select",""],["","67877019705","AMLODIPINE ","2.5MG","30","Select","Select",""],["","68382080701","TRAZODONE ","150MG","-60","Select","Select",""],["","16714036004","MONO-LINYAH ","0.25-35","84","Select","Select",""],["","16729004201","TACROLIMUS ","1MG","360","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","60","Select","Select",""],["","00378235193","ESOMEPRA ","40MG DR","90","Select","Select",""],["","68682011320","MESALAMINE ","0.375GM","-120","Select","Select",""],["","00469061773","PROGRAF ","1MG","-360","Select","Select",""],["","59746017206","PREDNISONE ","5MG","30","Select","Select",""],["","00093733401","MYCOPHENOLAT ","250MG","300","Select","Select",""],["","10702010101","METHYLPHENID ","10MG","60","Select","Select",""],["","00378427593","VALACYCLOVIR ","500MG","30","Select","Select",""],["","52268020101","SUTAB ","","24","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","",""],["No","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":""}]}]}