{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WARTHEL   D HENLEY","gend":1,"add":"308 W 34TH ST","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1954-11-12","age":"","mstatus":"","insh":"900042698*01","cliId":"4A78R78RC66","pno":"757\/623-0664","cno":"757\/623-0664","email":"","ename":"","eno":"","pphy":"KING, JODY P MD","ppno":"757\/446-8920","pcpadd":"SUITE 445 825 FAIRFAX AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"NORFOLK CITY","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":["H35.033","H25.13","E78.5","I10.","M50.322","M62.838","F41.9","M75.20","F32.9","R35.8","M54.2","M25.512","Z12.31","M47.816","M43.16","M76.22","M76.21","M76.892","M76.891","R06.00","M54.9","M25.552","M54.5","R13.10","R10.9","N20.0","K44.9","Z00.00","G47.00","E55.9","I67.9","I63.50","J45.909","K59.00","R06.09","Z86.73","R10.2","M16.0","Z12.11","R55.","R06.89","R06.02","H35.039","H04.123","R35.0","R39.89","R35.1","I65.22","I95.1","N39.3","L82.1","Z79.891"],"date":["2021-01-07","2021-07-23","2021-09-30","2021-10-05","2021-02-23","2021-02-23","2021-08-24","2021-02-01","2021-06-02","2021-02-01","2021-04-01","2021-04-01","2021-03-29","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-10-05","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-07-22","2021-06-07","2021-06-07","2021-06-02","2021-06-02","2021-06-02","2021-09-30","2021-08-24","2021-06-02","2021-09-30","2021-06-11","2021-06-11","2021-06-21","2021-05-17","2021-05-23","2021-10-05","2021-09-30","2021-08-10","2021-07-23","2021-07-23","2021-10-12","2021-10-12","2021-10-12","2021-08-25","2021-08-24","2021-09-10","2021-09-30","2021-09-30"],"priorHcc":["","",null,null,"","",null,"","","","","","","","","","","","",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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","172392670","DIAZEPAM","TAB 5MG","90","Select","Select",""],["","50742062001","NIFEDIPINE","TAB 30MG ER","90","Select","Select",""],["","115165903","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","90","Select","Select",""],["","62332049141","TIZANIDINE","CAP 2MG","-270","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","14","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","115165903","PROPRANOLOL HYDROCHLORIDE ","","90","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN ","","14","Select","Select",""],["","60505264807","TIZANIDINE HCL","","30","Select","Select",""],["","50742062001","NIFEDIPINE ER ","","-90","Select","Select",""],["","62332049141","TIZANIDINE HYDROCHLORIDE","","-90","Select","Select",""],["","00115165903","PROPRANOLOL HYDROCHLORIDE","","90","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN","","14","Select","Select",""],["","50742062001","NIFEDIPINE ER","","90","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM","","90","Select","Select",""],["","50742061510","METOPROLOL SUCCINATE ER","25MG ER","90","Select","Select",""],["","45802048678","DOCUSATE SODIUM","100MG","60","Select","Select",""],["","53746010901","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","5-325MG","60","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40MG","90","Select","Select",""],["","00093005805","TRAMADOL HCL                                                          ","TAB 50MG","90","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","14","Select","Select",""],["","62332049141","TIZANIDINE HYDROCHLORIDE                                              ","CAP 2MG","90","Select","Select",""],["","68180098003","LISINOPRIL                                                            ","TAB 10MG","90","Select","Select",""],["","00172392670","DIAZEPAM                                                              ","TAB 5MG","-90","Select","Select",""],["","00115165903","PROPRANOLOL HYDROCHLORIDE                                             ","TAB 10MG","90","Select","Select",""],["","60505264807","TIZANIDINE HCL                                                        ","CAP 2MG","-30","Select","Select",""],["","50742062001","NIFEDIPINE ER                                                         ","TAB 30MG ER","90","Select","Select",""],["","45802048678","DOCUSATE SODIUM                                                       ","CAP 100MG","60","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM                                                    ","TAB 20MG","-90","Select","Select",""],["","50742061510","METOPROLOL SUCCINATE ER                                               ","TAB 25MG ER","90","Select","Select",""],["","53746010901","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","60","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","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","",""],["Yes","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":""}]}]}