{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERONICA J HARRIS","gend":1,"add":"7517 GALVESTON BLVD","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1955-09-10","age":"","mstatus":"","insh":"900040213*01","cliId":"","pno":"757\/724-1287","cno":"","email":"","ename":"","eno":"","pphy":"WHITEHURST-DOSS, SUE NP","ppno":"757\/446-8920","pcpadd":"SUITE 445 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-7114","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","Z80.3","G47.30","G89.29","E66.01","Z86.69","E78.5","I10.","M62.81","I36.1","I27.20","M54.16","M17.12","M46.1","M25.561","M54.5","Z96.651","R06.00","F32.9","M79.7","E53.8","E55.9","D64.9","R73.09","R06.83","Z74.09","M48.062","R29.898","R20.0","M79.604","M79.605","M96.1","R06.02","Z98.1","R05.","Z51.81","Z79.891","Z12.11","I35.8","I51.89","R06.09","R07.9"],"date":["2021-02-15","2021-02-15","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-09-15","2021-11-30","2021-10-27","2021-11-15","2021-11-15","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-04-12","2021-12-02","2021-10-18","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-12-02","2021-11-30","2021-04-12","2021-01-05","2021-03-09","2021-03-09","2021-05-05","2021-11-15","2021-11-15","2021-11-15","2021-11-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","10702005601","OXYCODONE HYDROCHLORIDE ","10MG","60","Select","Select",""],["","65162010350","GABAPENTIN ","400MG","180","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","-90","Select","Select",""],["","00185094098","CHOLESTYRAMINE ","4GM","60","Select","Select",""],["","00085720601","DULERA ","100-5MCG","-13","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE ","50MCG","-16","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE ","25MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90","Select","Select",""],["","59310057922","PROAIR HFA ","","8","Select","Select",""],["","65862090901","CELECOXIB ","200MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90","Select","Select",""],["","65862001305","SERTRALINE HYDROCHLORIDE ","100MG","30","Select","Select",""],["","68462035701","POTASSIUM CHLORIDE ER ","10MEQ ER","180","Select","Select",""],["","29300013510","CLONIDINE HYDROCHLORIDE ","0.1MG","180","Select","Select",""],["","69452015120","VITAMIN D ","50000UNT","24","Select","Select",""],["","60432060416","PROMETHAZINE\/DEXTROMETHORPHAN ","DM","118","Select","Select",""],["","08290305269","BD INTEGRA SYRINGE\/3ML\/25G X 5\/8 ","25GX5\/8\"","2","Select","Select",""],["","69547035302","NARCAN ","","-2","Select","Select",""],["","57237007710","ONDANSETRON ODT ","4MG ODT","30","Select","Select",""],["","00143962125","CYANOCOBALAMIN ","1000MCG","25","Select","Select",""],["","08290309570","3ML LUER-LOK SYRINGE 25G X 5\/8\" ","25GX5\/8\"","6","Select","Select",""],["","53746051105","SPIRONOLACTONE ","25MG","-90","Select","Select",""],["","68462034690","LEVOCETIRIZINE DIHYDROCHLORIDE ","5MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE ","10MG","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}