{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRISTAIN   J SPEARMAN","gend":0,"add":"861 BANCKER ROAD APT 1","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1990-02-16","age":"","mstatus":"","insh":"900035857*01","cliId":"9H50A48MU20","pno":"757\/893-2629","cno":"757\/893-2629","email":"","ename":"","eno":"","pphy":"LAYNE, MICHAEL MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F79.","F90.2","G47.33","M08.00","Z79.899","Q90.9","F80.89","Z88.2","K43.9","R06.83","L25.9","Z23.","E66.9","Z68.41","E66.2","G47.10","G47.30","Z00.00","R63.5","G47.19","F81.89","Z91.89","R19.00","Z01.812","Z20.828","Z99.89","Z11.1","Z13.31","F80.2","K59.00"],"date":["2020-01-13","2020-01-30","2021-01-03","2021-10-05","2021-10-05","2021-03-09","2020-10-04","2020-10-04","2021-11-01","2020-08-12","2019-09-26","2020-11-06","2020-07-23","2019-09-26","2021-11-01","2021-03-09","2021-03-09","2021-03-09","2020-07-23","2020-08-12","2020-08-12","2020-08-12","2020-02-24","2020-10-01","2020-10-01","2020-11-06","2020-11-06","2021-03-09","2021-03-02","2021-11-01"],"priorHcc":["","","",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":[["","47335023583","METHOTREXATE","TAB 2.5MG","48","Select","Select",""],["","16837085550","PEPCID AC","TAB 20MG","90","Select","Select",""],["","69315012710","FOLIC ACID","TAB 1000MCG","90","Select","Select",""],["","45802005535","TRIAMCINOLON","OIN 0.001","-90","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","180","Select","Select",""],["","49035065071","EQ FAMOTIDIN","TAB 20MG","100","Select","Select",""],["","49348081705","ACID REDUCER","TAB 20MG","100","Select","Select",""],["","45802005505","TRIAMCINOLONE ACETONIDE","","-90","Select","Select",""],["","16571020150","DICLOFENAC SODIUM DR ","","180","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","49035065071","EQ FAMOTIDINE MAXIMUM STRENGTH","","90","Select","Select",""],["","49348081705","SM ACID REDUCER MAXIMUM STRENGTH","","100","Select","Select",""],["","16837085550","PEPCID AC MAXIMUM STRENGTH","","90","Select","Select",""],["","16729048601","METHOTREXATE SODIUM","","48","Select","Select",""],["","16571020150","DICLOFENAC SODIUM DR","","180","Select","Select",""],["","47335023583","METHOTREXATE                                                          ","TAB 2.5MG","16","Select","Select",""],["","68645014059","FAMOTIDINE                                                            ","TAB 20MG","90","Select","Select",""],["","45802005505","TRIAMCINOLONE ACETONIDE                                               ","OIN 0.001","-90","Select","Select",""],["","49348081705","SM ACID REDUCER MAXIMUM STRENGTH                                      ","TAB 20MG","100","Select","Select",""],["","16837085550","PEPCID AC MAXIMUM STRENGTH                                            ","TAB 20MG","90","Select","Select",""],["","69315012710","FOLIC ACID                                                            ","TAB 1000MCG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","49035065071","EQ FAMOTIDINE MAXIMUM STRENGTH                                        ","TAB 20MG","90","Select","Select",""],["","16571020150","DICLOFENAC SODIUM DR                                                  ","TAB 75MG DR","180","Select","Select",""],["","16729048601","METHOTREXATE SODIUM                                                   ","TAB 2.5MG","48","Select","Select",""],["","11523435702","                                                                      "," ","14","Select","Select",""],["","45802086866","POLYETHYLENE GLYCOL 3350                                              ","POW 3350 NF","14","Select","Select",""],["","68645058259","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","90","Select","Select",""],["","11523726808","MIRALAX                                                               ","POW 3350 NF","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":""}]}]}