{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEWIS J SOUTHALL","gend":0,"add":"801 BOUSH ST STE 302","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1957-04-07","age":"","mstatus":"","insh":"900040306*01","cliId":"","pno":"757\/625-6161","cno":"","email":"","ename":"","eno":"","pphy":"BRITTON, BRUCE MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":"","pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F42.9","F41.9","F79.","Z20.822","B35.1","L60.0","E11.00","G93.41","E87.2","N17.9","D68.9","I50.32","I48.20","R65.10","E87.5","I11.0","I25.10","I25.2","D69.59","M54.2","S19.9XXA","R41.82","S09.90XA","J18.9","Z12.11","I08.1","I48.0","Q21.1","R39.81","N39.46","I07.9","Z79.01","I48.91","A41.9","R09.89","E11.9","Z00.00","Z20.828","J30.9","Z68.23","I10.","R60.0","I50.30","R06.2","F72.","F33.3","F41.1","F31.81","I50.33","Z68.25","R06.02","I49.9","Z23.","K59.00","D50.9","R79.1","Z13.31"],"date":["2021-04-13","2021-11-18","2021-08-11","2021-04-13","2021-08-17","2021-08-17","2021-04-17","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-14","2021-06-21","2021-07-14","2021-08-30","2021-07-14","2020-10-30","2020-10-30","2020-12-17","2021-06-21","2021-09-10","2021-04-14","2021-04-14","2021-11-18","2021-06-21","2021-01-06","2021-03-29","2021-06-28","2021-09-22","2021-08-24","2021-09-10","2021-08-24","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-09-22","2021-10-26","2021-08-30","2021-10-26","2021-09-10","2021-04-26","2020-11-24","2021-04-13","2020-12-17"],"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":[["","65162075750","DIVALPROEX SODIUM ER ","500MG ER","56","Select","Select",""],["","00832121600","JANTOVEN ","5MG","16","Select","Select",""],["","62037083110","METOPROLOL SUCCINATE ER ","50MG ER","28","Select","Select",""],["","67877024710","QUETIAPINE FUMARATE ","300MG","28","Select","Select",""],["","00093171401","WARFARIN SODIUM ","2.5MG","12","Select","Select",""],["","68682099798","DILTIAZEM HYDROCHLORIDE ER ","240MG ER","28","Select","Select",""],["","68382007216","PRAVASTATIN SODIUM ","40MG","28","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","56","Select","Select",""],["","62037099910","POTASSIUM CHLORIDE ER ","20MEQ ER","28","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE ","50MCG","16","Select","Select",""],["","00904699860","DOCUSATE SODIUM ","100MG","60","Select","Select",""],["","53885065701","ONETOUCH VERIO ","VERIO","1","Select","Select",""],["","00536222075","GAS RELIEF ","20\/0.3ML","30","Select","Select",""],["","08528147401","TRUE METRIX ","","-1","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G ","PLUS 33G","100","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIPS ","VERIO","50","Select","Select",""],["","08290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\" ","32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR ","100\/ML","15","Select","Select",""],["","00002771559","BASAGLAR KWIKPEN ","100UNIT","-15","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN ","100\/ML","15","Select","Select",""],["","08222032591","ULTICARE INSULIN SAFETY SYRINGE\/0.5ML\/29G X 1\/2\" ","0.5\/29G","100","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT ","VERIO RE","1","Select","Select",""],["","08290320119","BD PEN NEEDLE\/MINI\/ULTRA-FINE\/31G X 5MM ","31GX5MM","100","Select","Select",""],["","00002879959","HUMALOG KWIKPEN ","100\/ML","15","Select","Select",""],["","11822003960","RA COL-RITE ","100MG","60","Select","Select",""],["","00904693181","PEG 3350 ","","30","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","10","Select","Select",""],["","38396054208","LEADER GLUCOSE ","RASPBERY","50","Select","Select",""],["","50383078530","EQUALIZER GAS RELIEF ","40\/0.6ML","30","Select","Select",""],["","00574006945","GLUTOSE 45 ","","112","Select","Select",""],["","50730300302"," ","","1","Select","Select",""],["","08496280801","EASY TOUCH LANCETS 28G\/PRESSURE ACTIVATED ","LANC\/28G","100","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","35","Select","Select",""],["","00378022201","CHLORTHALIDONE ","25MG","28","Select","Select",""],["","08290320122","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM ","32GX4MM","100","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}