{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDAN   M FRY","gend":0,"add":"7113 CARRIAGE PINES DR","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1992-04-29","age":"","mstatus":"","insh":"900038972*01","cliId":"9QC7PN7CX60","pno":"540\/683-4999","cno":"540\/683-4999","email":"","ename":"","eno":"","pphy":"OHANIAN, KARO G MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":100340,"pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"804\/878-4452","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I49.9","I63.9","R53.1","B34.9","R11.2","F12.10","Z20.828","F50.9","R07.0","R11.0","R74.8","S10.11XA","X58.XXXA","R07.89","F31.9","F90.9","F17.210","Z88.8","Z79.899","R20.2","R05.","G81.90","J45.901","J45.909","I20.0","Z74.3","R68.84","R07.9","J45.20","Z76.89","F43.24","Z91.048","S09.91XA","S00.91XA","Y04.8XXA","T14.90XA","R74.01","R29.90","S01.81XD","Z51.89","S01.81XA","J30.1","S00.83XA","T14.8XXA","S09.90XA","M54.5","M25.522","W19.XXXA","S09.93XA","R27.0","J06.9","R09.82","S00.81XA","E78.5","F17.200"],"date":["2020-06-09","2020-06-09","2020-09-07","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-09-12","2020-09-12","2021-08-10","2020-09-12","2020-09-12","2020-09-21","2021-08-10","2020-09-21","2021-07-14","2021-07-14","2021-01-16","2020-06-09","2020-07-25","2020-06-10","2020-09-07","2021-01-16","2020-09-21","2020-09-21","2021-01-16","2021-01-16","2021-08-10","2021-01-05","2020-09-12","2020-09-12","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-02-09","2020-06-09","2021-05-03","2021-05-03","2021-04-17","2021-05-19","2021-06-02","2021-06-02","2021-06-02","2021-04-06","2021-04-06","2021-04-06","2021-06-02","2021-06-02","2021-07-14","2021-07-14","2021-06-02","2021-08-10","2021-08-10"],"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":[["","65862023060","LAMOTRIGINE","TAB 200MG","-30","Select","Select",""],["","43547030503","ARIPIPRAZOLE","TAB 15MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","93317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","30","Select","Select",""],["","126002292","PREVDNT 5000","PST 1.1-5%","300","Select","Select",""],["","603243721","BENZTROPINE","TAB 0.5MG","60","Select","Select",""],["","904073436","TRIPLE ANTIB","OIN ","14","Select","Select",""],["","904198280","MAPAP","TAB 325MG","20","Select","Select",""],["","51645070310","ACETAMIN","TAB 325MG","20","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","126002292","PREVIDENT 5000 ENAMEL PROTECT","","300","Select","Select",""],["","603243721","BENZTROPINE MESYLATE ","","60","Select","Select",""],["","55111053301","DIVALPROEX SODIUM ER ","","30","Select","Select",""],["","57237004705","DIVALPROEX SODIUM DR ","","90","Select","Select",""],["","93506201","HYDROXYZINE HCL ","","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","49483060350","IBUPROFEN ","","20","Select","Select",""],["","51645070310","ACETAMINOPHEN ","","20","Select","Select",""],["","904073436","TRIPLE ANTIBIOTIC","","14","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","00603243721","BENZTROPINE MESYLATE","","60","Select","Select",""],["","57237004705","DIVALPROEX SODIUM DR","","90","Select","Select",""],["","55111053301","DIVALPROEX SODIUM ER","","30","Select","Select",""],["","23155050210","HYDROXYZINE HCL","","-30","Select","Select",""],["","51645070310","ACETAMINOPHEN","","20","Select","Select",""],["","63824000834","MUCINEX","600MG ER","20","Select","Select",""],["","42806071405","BENZONATATE","100MG","30","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE","COVID-19","0","Select","Select",""],["","00536589688","NICOTINE TRANSDERMAL SYSTEM","21MG\/24H","28","Select","Select",""],["","00603243721","BENZTROPINE MESYLATE                                                  ","TAB 0.5MG","60","Select","Select",""],["","65862023060","LAMOTRIGINE                                                           ","TAB 200MG","30","Select","Select",""],["","00126002292","PREVIDENT 5000 ENAMEL PROTECT                                         ","PST 1.1-5%","300","Select","Select",""],["","55111053301","DIVALPROEX SODIUM ER                                                  ","TAB 250MG ER","30","Select","Select",""],["","43547030503","ARIPIPRAZOLE                                                          ","TAB 15MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE                                                           ","TAB 15MG","30","Select","Select",""],["","57237004705","DIVALPROEX SODIUM DR                                                  ","TAB 250MG DR","90","Select","Select",""],["","00093506201","HYDROXYZINE HCL                                                       ","TAB 50MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","Select","Select",""],["","00904198280","MAPAP                                                                 ","TAB 325MG","20","Select","Select",""],["","49483060350","IBUPROFEN                                                             ","TAB 600MG","20","Select","Select",""],["","00904073436","TRIPLE ANTIBIOTIC                                                     ","OIN ","14","Select","Select",""],["","42806071405","BENZONATATE                                                           ","CAP 100MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","51645070310","ACETAMINOPHEN                                                         ","TAB 325MG","20","Select","Select",""],["","00536589688","NICOTINE TRANSDERMAL SYSTEM                                           ","DIS 21MG\/24H","28","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE                                              ","INJ COVID-19","0","Select","Select",""],["","63824000834","MUCINEX                                                               ","TAB 600MG ER","20","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":""}]}]}