{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LUCINDA M BROWN","gend":1,"add":"801 BOUSH ST STE 302","city":"NORFOLK","state":"VA","zip":23510,"dob":"1924-10-10","age":"","mstatus":"","insh":"900040273*01","cliId":"","pno":"757\/625-6161","cno":"757\/625-6161    ","email":"","ename":"","eno":"","pphy":"GIBSON, AMANDA R 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 - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Southside","aligned":"Y","ano":"757\/625-6161, ","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":["R39.9","M48.50XA","M81.0","R32.","L98.9","R22.2","C83.30","S22.089A","N18.30","R06.00","R53.1","M48.54XA","M43.16","M43.17","M54.6","H90.0","H61.23","N39.0","W19.XXXA","Y92.009","F42.9","Z20.822","Z20.828","I70.203","B35.1","M19.90","F79.","R26.2","E83.52","I10.","M62.81","M54.5","R29.898","F41.9","L57.0","Z85.828","C83.32","M80.08XA","M84.58XA","R91.1","M17.0","R29.6","F70.","H91.90","Z92.3","Z79.899","Z88.2"],"date":["2020-11-25","2020-12-18","2020-11-24","2020-11-24","2021-02-23","2021-04-09","2021-04-09","2021-04-06","2020-12-18","2021-03-04","2021-03-29","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2021-02-18","2021-02-18","2020-11-25","2020-12-18","2020-12-18","2021-03-25","2021-03-16","2021-03-23","2020-12-14","2021-03-25","2021-01-26","2021-01-26","2021-03-26","2021-03-26","2021-03-26","2021-03-30","2020-11-17","2021-04-09","2021-04-09","2021-01-21","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25"],"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":[["","60505082306","CALCITONIN","SPR 200\/ACT","4","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","90","Select","Select",""],["","187540004","JUBLIA","SOL 0.1","4","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","5","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","44","Select","Select",""],["","904576960","ARTHRTS PAIN","TAB 650MG","112","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","574705050","BISACODYL","SUP 10MG","15","Select","Select",""],["","904676316","ROBAFEN","SYP 100\/5ML","237","Select","Select",""],["","10702001001","HYDROXYZ HCL","TAB 10MG","30","Select","Select",""],["","54040444","MORPHINE SUL","SOL 100\/5ML","-30","Select","Select",""],["","57896045801","SENNA PLUS","TAB 8.6-50MG","132","Select","Select",""],["","713052612","PROMETHEGAN","SUP 25MG","20","Select","Select",""],["","54353244","LORAZEPAM","CON 2MG\/ML","30","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","45802073032","ACETAMIN","SUP 650MG","40","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}