{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLOYD   H TUCKER","gend":0,"add":"553 OSCEOLA AVE","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1950-02-19","age":"","mstatus":"","insh":"900036283*01","cliId":"4C28PX5HN21","pno":"757\/394-6148","cno":"757\/394-6148","email":"","ename":"","eno":"","pphy":"MANSER, THOMAS 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":"757\/394-6148","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-2651","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","N18.9","Z79.01","M54.5","E20.9","E11.65","Z95.0","I49.5","I25.10","E78.2","M48.061","M47.816","M48.07","Z98.1","M54.16","R06.02","I21.4","I48.0","I50.41","I20.0","R06.89","I50.43","R60.9","N17.9","N18.3","I50.23","E87.2","E11.9","Z79.4","Z45.2","Z23.","Z09.","I12.9","E11.22","N18.32","Z00.00","Z13.31","I50.22","M19.90","M54.30","M85.80","N18.30","Z45.018","Z87.891","Z13.9","M43.16","E11.8","Z79.899","I50.9","I42.8","I35.8","I34.8","R53.83","Z20.828","M46.1","M96.1","E78.5","E83.51","I35.1","R35.8","Z12.5","I77.810","I51.7","J44.9","R91.8","I16.0","I13.10","R60.0","I35.2","Z95.1","M51.36","I48.91","J96.01","I35.0","J90.","I50.20","M25.78","I13.0","K21.9","I25.2","F17.210","Z96.651","Z79.82","R63.4","M54.2","G43.109","R07.9","I25.708","G89.29","I11.0","E11.10","R77.8","I34.0","E11.42","M79.89","T46.1X5A","D63.1","I08.0","I25.5","M47.26","I50.32","I20.8","I73.9","M54.9","I11.9","E78.00","R01.1","J84.10","I71.2","I28.1","R09.81","R73.9","E11.40","M53.3","R10.9","D64.9","T82.111A","R06.00","K21.0","F17.200","R13.0","Z01.818","E13.10","E16.2","D50.9","Z45.010","M25.552","I48.92","E11.51","Z86.73","Z95.5","R79.89","N19.","E11.69","E87.70","Z91.14","R60.1","N18.6","N18.4","I50.21","J81.1","M48.00","I63.81","K74.60","Z99.2","J98.11","I08.1","I42.9","I35.9","R39.12","I13.2","E44.0","I42.0","Z12.11"],"date":["2021-08-13","2021-06-24","2021-06-30","2021-04-12","2020-02-19","2021-07-21","2021-08-13","2021-03-22","2021-08-13","2021-06-30","2021-06-24","2020-12-03","2020-12-03","2021-02-04","2021-03-12","2020-08-26","2020-09-02","2021-08-13","2020-08-27","2020-09-08","2021-08-13","2020-09-08","2020-09-29","2021-07-15","2020-09-22","2021-07-28","2020-09-22","2021-08-13","2020-12-03","2020-09-14","2020-09-25","2020-09-30","2021-07-02","2021-06-30","2021-07-12","2021-07-21","2021-01-27","2020-12-15","2021-07-21","2020-12-15","2020-12-15","2021-07-08","2021-06-21","2021-04-26","2021-01-27","2021-06-30","2020-09-22","2021-08-13","2021-07-04","2021-08-13","2021-08-13","2020-09-29","2020-09-29","2020-12-07","2021-04-12","2021-04-12","2021-07-13","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2020-07-02","2020-11-09","2021-06-30","2021-07-02","2020-09-22","2020-09-22","2020-09-22","2021-07-07","2021-07-13","2021-07-05","2021-07-14","2020-08-28","2020-08-28","2021-07-02","2021-07-12","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2021-08-13","2020-02-20","2020-02-20","2020-04-27","2020-05-15","2020-12-15","2020-08-25","2020-08-29","2020-08-25","2020-08-26","2020-09-07","2020-08-29","2020-08-29","2021-07-05","2020-08-29","2020-09-07","2020-11-06","2020-05-06","2021-01-06","2021-06-24","2021-07-06","2021-08-13","2021-08-13","2020-07-01","2020-08-21","2020-08-25","2020-08-21","2020-09-16","2020-09-22","2021-01-13","2021-03-16","2021-06-15","2021-07-14","2020-01-02","2020-08-21","2020-08-21","2020-08-21","2020-01-09","2021-06-24","2020-08-29","2020-09-22","2020-09-25","2020-02-28","2020-07-30","2020-08-25","2020-08-25","2021-06-30","2020-08-25","2020-08-25","2021-07-08","2020-09-02","2021-07-12","2020-09-07","2021-07-04","2021-07-21","2021-07-28","2021-07-05","2021-07-05","2021-06-24","2021-06-24","2021-06-24","2021-07-21","2021-06-30","2021-07-07","2021-07-14","2021-07-02","2021-07-04","2021-06-30","2021-06-30","2021-06-30","2021-05-23"],"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":[["","31722094101","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","50111032701","HYDRALAZINE ","25MG","180","Select","Select",""],["","00228291809","DILTIAZEM ","360MG ER","90","Select","Select",""],["","00078065920","ENTRESTO ","24-26MG","60","Select","Select",""],["","00006011231","JANUVIA ","50MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","30","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","20","Select","Select",""],["","64980052810","SODIUM ","650MG","90","Select","Select",""],["","65862008701","BISOPROL ","10MG","30","Select","Select",""],["","68382005001","MELOXICAM ","7.5MG","30","Select","Select",""],["","11822365670","ACETAMIN ","500MG","20","Select","Select",""],["","16714044301","ENALAPRIL ","5MG","30","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","30","Select","Select",""],["","08290324912","INSULIN ","1ML\/31G","100","Select","Select",""],["","51862024160","AMIODARONE ","200MG","30","Select","Select",""],["","68382065105","ISOSORB ","60MG ER","30","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","42","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","-1","Select","Select",""],["","00310654004","BYDUREON ","2\/0.85ML","3","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","-2","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","43598029390","PREGABALIN ","75MG","60","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","50111032701","","25MG","180","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}