{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOROTHY   M PEACE","gend":1,"add":"801 BOUSH ST STE 302","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1962-07-05","age":"","mstatus":"","insh":"900040317*01","cliId":"4QK6WD4KQ69","pno":"757\/625-6161","cno":"757\/625-6161","email":"","ename":"","eno":"","pphy":"MILLS, AARON E DO","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":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5242","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N20.0","R31.9","E55.9","I10.","Z00.00","R73.03","N18.30","R51.9","Z20.822","Z12.31","G40.311","F71.","G31.9","M31.6","R70.0","R41.82","E11.9","E03.9","G31.89","F79.","M81.0","G40.909","Z79.84","Z79.899","Z86.79","D50.9","Z12.11","Z01.419","Z12.39","Z12.4","N17.9","N39.0","E04.2","K63.5","K62.1","K57.30","K64.1","F06.31","F02.80","M85.89","Z23.","R09.89","H25.13","M18.0"],"date":["2021-02-22","2021-02-22","2021-01-28","2021-07-12","2021-03-01","2021-10-19","2021-10-12","2021-10-12","2021-03-01","2020-09-22","2021-09-28","2021-09-13","2021-03-31","2021-03-03","2021-10-12","2021-03-03","2021-09-08","2021-03-03","2021-03-03","2021-03-03","2021-10-12","2021-04-27","2021-03-03","2021-03-03","2021-03-03","2021-03-23","2021-06-10","2020-08-31","2020-08-31","2020-08-31","2021-02-03","2021-02-03","2021-07-02","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-09-13","2021-09-13","2021-07-07","2021-10-12","2021-10-19","2021-09-08","2021-10-12"],"priorHcc":["","","","","",null,null,null,"","",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":[["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","31722053705","LEVETIRACETA","TAB 500MG","168","Select","Select",""],["","131247835","VIMPAT","TAB 100MG","28","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","28","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","28","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","112","Select","Select",""],["","60505311108","OLANZAPINE","TAB 5MG","14","Select","Select",""],["","591387560","MEMANTINE","TAB HCL 10MG","56","Select","Select",""],["","66685100200","AMOX\/K CLAV","TAB 500-125","10","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","28","Select","Select",""],["","904641292","CALC ANTACID","CHW 500MG","60","Select","Select",""],["","10135025460","CALCIUM CARB","CHW 500MG","60","Select","Select",""],["","51672126302","NYSTAT\/TRIAM","CRE ","30","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","90","Select","Select",""],["","603254421","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","31722053705","LEVETIRACETAM ","","168","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","","-16","Select","Select",""],["","62756014202","METFORMIN HYDROCHLORIDE ER","","28","Select","Select",""],["","69097083412","SERTRALINE HCL","","28","Select","Select",""],["","591387560","MEMANTINE HYDROCHLORIDE","","56","Select","Select",""],["","51672126302","NYSTATIN\/TRIAMCINOLONE","","30","Select","Select",""],["","66685100200","AMOXICILLIN\/CLAVULANATE POTASSIUM ","","10","Select","Select",""],["","603254421","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE ","","30","Select","Select",""],["","904641292","CALCIUM ANTACID ","","60","Select","Select",""],["","10135025460","CALCIUM CARBONATE","","60","Select","Select",""],["","31722053705","LEVETIRACETAM","","168","Select","Select",""],["","00603254421","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE","","30","Select","Select",""],["","66685100200","AMOXICILLIN\/CLAVULANATE POTASSIUM","","10","Select","Select",""],["","00904641292","CALCIUM ANTACID","","60","Select","Select",""],["","51672400201","NORTRIPTYLINE HCL","25MG","33","Select","Select",""],["","68180051303","LISINOPRIL                                                            ","TAB 5MG","28","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","-16","Select","Select",""],["","62756014202","METFORMIN HYDROCHLORIDE ER                                            ","TAB 500MG ER","28","Select","Select",""],["","00131247835","VIMPAT                                                                ","TAB 100MG","28","Select","Select",""],["","31722053705","LEVETIRACETAM                                                         ","TAB 500MG","168","Select","Select",""],["","69097083412","SERTRALINE HCL                                                        ","TAB 50MG","28","Select","Select",""],["","00591387560","MEMANTINE HYDROCHLORIDE                                               ","TAB HCL 10MG","56","Select","Select",""],["","69097086107","ZONISAMIDE                                                            ","CAP 100MG","112","Select","Select",""],["","60505311108","OLANZAPINE                                                            ","TAB 5MG","14","Select","Select",""],["","51672126302","NYSTATIN\/TRIAMCINOLONE                                                ","CRE ","30","Select","Select",""],["","00603254421","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE                                     ","TAB ","30","Select","Select",""],["","66685100200","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","TAB 500-125","10","Select","Select",""],["","59746017506","PREDNISONE                                                            ","TAB 20MG","90","Select","Select",""],["","43386009019","GAVILYTE-G                                                            ","SOL ","4000","Select","Select",""],["","10135025460","CALCIUM CARBONATE                                                     ","CHW 500MG","60","Select","Select",""],["","00904641292","CALCIUM ANTACID                                                       ","CHW 500MG","60","Select","Select",""],["","51672400201","NORTRIPTYLINE HCL                                                     ","CAP 25MG","33","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":""}]}]}