{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDNA   J SMITHWICK","gend":1,"add":"C\/O HOPE HOUSE FOUNDATION 801 BOUSH ST STE 320","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1951-08-25","age":"","mstatus":"","insh":"900040307*01","cliId":"","pno":"757\/625-6161","cno":"","email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","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":["S00.03XA","K21.9","E11.9","E78.00","Z79.899","R53.83","N39.0","N18.31","F25.9","R80.9","D89.0","D64.89","M79.632","M25.532","M79.642","M89.9","R26.81","M79.639","B37.2","M85.80","M18.12","S52.502A","H10.31","N18.9","D64.9","M25.512","S49.92XA","R07.89","S40.012A","E11.22","R21.","L29.9","T50.905A","Z79.4","Z88.5","Z88.8","R44.3","Z23.","F79.","F20.9","S42.122A","F25.0","F70.","H25.13","F20.3","R51.9","Z78.0","Z82.62","Z13.820","Z00.00","N28.1","R19.00","K59.00","R10.9","T14.90XA","Z74.3","M85.89","R26.89","K44.9","Z13.31","W19.XXXA","L30.4","Z71.9","H10.9","N28.89","I49.9","R07.9","R06.02","R41.82","S09.90XA","Z12.11","M85.88","S42.301D","N18.30","R10.84"],"date":["2020-10-10","2021-10-19","2021-11-02","2020-10-07","2020-10-07","2020-10-07","2021-07-17","2020-12-08","2020-12-08","2021-11-02","2020-12-08","2020-12-08","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-03-02","2021-03-04","2021-03-04","2021-11-30","2021-04-21","2021-04-21","2021-03-18","2021-09-23","2020-09-03","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-11-24","2021-10-19","2021-09-23","2021-03-25","2021-03-10","2021-03-29","2021-03-29","2021-04-19","2021-11-04","2020-10-07","2021-01-29","2021-01-29","2021-01-29","2021-03-23","2021-09-23","2021-09-23","2021-11-30","2021-11-30","2020-10-10","2020-10-10","2021-01-29","2021-06-02","2021-10-19","2020-09-21","2020-10-07","2020-11-12","2020-11-12","2021-02-12","2021-09-23","2020-10-07","2020-10-07","2020-10-07","2020-10-10","2020-10-10","2020-10-14","2021-03-25","2021-03-25","2021-03-25","2020-10-14"],"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":[["","50111043403","TRAZODONE HYDROCHLORIDE                                               ","100MG","28","Select","Select",""],["","60505313508","QUETIAPINE FUMARATE                                                   ","200MG","28","Select","Select",""],["","68382003616","VENLAFAXINE HCL ER                                                    ","150MG ER","28","Select","Select",""],["","00378395305","ATORVASTATIN CALCIUM                                                  ","80MG","28","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM                                                   ","40MG","56","Select","Select",""],["","00781223410","OMEPRAZOLE                                                            ","40MG","28","Select","Select",""],["","00472080460","DESONIDE                                                              ","0.05%","60","Select","Select",""],["","00378025701","HALOPERIDOL                                                           ","1MG","28","Select","Select",""],["","43386031214","GAVILAX                                                               ","","510","Select","Select",""],["","00378110501","GLIPIZIDE                                                             ","5MG","14","Select","Select",""],["","16729017017","ESCITALOPRAM OXALATE                                                  ","20MG","28","Select","Select",""],["","57896062912","GERI-LANTA                                                            ","","1065","Select","Select",""],["","00093716498","TOLTERODINE TARTRATE ER                                               ","4MG ER","28","Select","Select",""],["","51672129803","KETOCONAZOLE                                                          ","2%","60","Select","Select",""],["","94030000269","EMBRACE TALK BLOOD GLUCOSE MONITORING SYSTEM                          ","SYSTEM","1","Select","Select",""],["","08496280801","EASY TOUCH LANCETS 28G\/PRESSURE ACTIVATED                             ","LANC\/28G","100","Select","Select",""],["","64980051501","OFLOXACIN                                                             ","0.3% OP","5","Select","Select",""],["","00536129383","ANTACID REGULAR STRENGTH                                              ","REG ST","1065","Select","Select",""],["","00065143302","SYSTANE BALANCE RESTORATIVE FORMULA                                   ","RESTOR","10","Select","Select",""],["","50383079516","LACTULOSE                                                             ","10GM\/15","473","Select","Select",""],["","65862052890","VENLAFAXINE HYDROCHLORIDE ER                                          ","75MG ER","-30","Select","Select",""],["","00093738001","VENLAFAXINE HCL                                                       ","37.5MG","26","Select","Select",""],["","00093314705","CEPHALEXIN                                                            ","500MG","21","Select","Select",""],["","00591090030","GLIPIZIDE ER                                                          ","2.5MG","27","Select","Select",""],["","70000036301","HEARTBURN RELIEF EXTRA STRENGTH                                       ","CHERRY","1065","Select","Select",""],["","67877025180","TRIAMCINOLONE ACETONIDE                                               ","0.10%","80","Select","Select",""],["","80777027398","MODERNA COVID-19 VACCINE                                              ","COVID-19","0","Select","Select",""],["","51645073515","CALCIUM ANTACID                                                       ","500MG","30","Select","Select",""],["","00904519966","NATURAL FIBER THERAPY                                                 ","THERAPY","538","Select","Select",""],["","96295013818","DAILY FIBER                                                           ","","576","Select","Select",""],["","00363015798","ASPIRIN                                                               ","325MG","42","Select","Select",""],["","65162062711","TRAMADOL HCL                                                          ","50MG","21","Select","Select",""],["","58160082311","SHINGRIX                                                              ","50\/0.5ML","1","Select","Select",""],["","00456120130","LINZESS                                                               ","145MCG","30","Select","Select",""],["","00781324664","ENOXAPARIN SODIUM                                                     ","40\/0.4ML","8","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":""}]}]}