{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEISHA   S TURNER","gend":1,"add":"801 BOUSH ST STE 302","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1981-11-22","age":"","mstatus":"","insh":"900040314*01","cliId":"4C26V55DU46","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","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":["R39.81","E66.01","H40.053","G47.33","Z11.3","Z12.4","E03.9","Z30.46","F25.9","Z00.00","F70.","I10.","Z13.31","G47.14","E66.9","F79.","J45.901","N92.3","Z12.9","A53.9","L21.9","Z87.2","K05.5","I89.0","I87.2","I82.403","Z68.42","Z91.030","Z91.040","Z96.642","M79.89","J20.9","Z20.828","R05.","R50.9","R07.0","M70.62","F43.21","F71.","L20.9","H10.45","M25.552","F25.0","F41.1","Z79.899","R53.83"],"date":["2020-10-30","2020-10-30","2021-10-08","2021-10-19","2021-01-20","2021-01-20","2020-11-02","2021-02-23","2020-09-01","2020-11-06","2020-11-06","2021-05-26","2020-11-06","2020-09-25","2021-05-26","2020-10-30","2020-11-02","2021-01-15","2021-01-15","2021-02-23","2021-07-30","2021-03-12","2021-03-12","2021-08-23","2021-06-07","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2021-06-18","2021-10-11","2021-10-11","2021-07-30","2021-10-08","2021-09-24","2021-10-25","2021-10-25","2021-10-25","2021-08-23"],"priorHcc":["","",null,null,"","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","",null,null,"",null,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":[["","168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","28","Select","Select",""],["","93005405","BUSPIRONE","TAB 10MG","84","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","21","Select","Select",""],["","27241000450","RISPERIDONE","TAB 2MG","28","Select","Select",""],["","70727052925","ROCKLATAN","DRO ","2","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","28","Select","Select",""],["","1234567891",""," ","2","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","28","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","378181377","LEVOTHYROXIN","TAB 125MCG","28","Select","Select",""],["","63646001004","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","168000616","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","54001925","PREDNISONE","TAB 50MG","-5","Select","Select",""],["","61314022710","TIMOLOL MAL","SOL 0.5% OP","10","Select","Select",""],["","143314205","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","832046515","NYAMYC","POW 100000","15","Select","Select",""],["","47335093890","AZELASTINE","DRO 0.0005","6","Select","Select",""],["","55111072510","MONTELUKAST SODIUM ","","28","Select","Select",""],["","16729020216","BUSPIRONE HYDROCHLORIDE","","84","Select","Select",""],["","378181377","LEVOTHYROXINE SODIUM ","","28","Select","Select",""],["","143314205","DOXYCYCLINE HYCLATE","","20","Select","Select",""],["","70727052925","ROCKLATAN ","","2","Select","Select",""],["","69097012815","AMLODIPINE BESYLATE","","28","Select","Select",""],["","13668000905","CITALOPRAM HYDROBROMIDE","","28","Select","Select",""],["","61314022710","TIMOLOL MALEATE ","","10","Select","Select",""],["","47335093890","AZELASTINE HCL","","6","Select","Select",""],["","168014616","HYDROCORTISONE","","454","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","168000616","TRIAMCINOLONE ACETONIDE","","454","Select","Select",""],["","23155050110","HYDROXYZINE HYDROCHLORIDE ","","30","Select","Select",""],["","00378181377","LEVOTHYROXINE SODIUM","","28","Select","Select",""],["","61314022710","TIMOLOL MALEATE","","10","Select","Select",""],["","55111072510","MONTELUKAST SODIUM","","28","Select","Select",""],["","23155050110","HYDROXYZINE HYDROCHLORIDE","","30","Select","Select",""],["","00378022201","CHLORTHALIDONE","","28","Select","Select",""],["","61442012110","FAMOTIDINE                                                            ","TAB 20MG","28","Select","Select",""],["","68382011505","RISPERIDONE                                                           ","TAB 2MG","28","Select","Select",""],["","13668000905","CITALOPRAM HYDROBROMIDE                                               ","TAB 10MG","28","Select","Select",""],["","29300022010","MONTELUKAST SODIUM                                                    ","TAB 10MG","28","Select","Select",""],["","00054001925","PREDNISONE                                                            ","TAB 50MG","5","Select","Select",""],["","70727052925","ROCKLATAN                                                             ","DRO ","2","Select","Select",""],["","47335093890","AZELASTINE HCL                                                        ","DRO 0.0005","6","Select","Select",""],["","00173071920","FLOVENT HFA                                                           ","AER 110MCG","12","Select","Select",""],["","00378181377","LEVOTHYROXINE SODIUM                                                  ","TAB 125MCG","28","Select","Select",""],["","00143314205","DOXYCYCLINE HYCLATE                                                   ","CAP 100MG","20","Select","Select",""],["","49502010202","EPINEPHRINE                                                           ","INJ 0.3MG","2","Select","Select",""],["","00168014616","HYDROCORTISONE                                                        ","OIN 0.025","454","Select","Select",""],["","00168000616","TRIAMCINOLONE ACETONIDE                                               ","OIN 0.001","454","Select","Select",""],["","16729020216","BUSPIRONE HYDROCHLORIDE                                               ","TAB 10MG","84","Select","Select",""],["","69097012815","AMLODIPINE BESYLATE                                                   ","TAB 10MG","28","Select","Select",""],["","43547035411","LISINOPRIL                                                            ","TAB 20MG","56","Select","Select",""],["","63646001004","KETOCONAZOLE                                                          ","SHA 0.02","120","Select","Select",""],["","61314022710","TIMOLOL MALEATE                                                       ","SOL 0.5% OP","10","Select","Select",""],["","01234567891","                                                                      "," ","2","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","18","Select","Select",""],["","00832046515","NYAMYC                                                                ","POW 100000","15","Select","Select",""],["","23155050110","HYDROXYZINE HYDROCHLORIDE                                             ","TAB 25MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","18","Select","Select",""],["","00378022201","CHLORTHALIDONE                                                        ","TAB 25MG","28","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":""}]}]}