{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANE   A MIRMELSTEIN","gend":1,"add":"7616 MARTONE RD","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1959-12-21","age":"","mstatus":"","insh":"1157040*01","cliId":"","pno":"757\/408-4567","cno":"757\/408-4567","email":"","ename":"","eno":"","pphy":"RYAL, JENNIFER L MD","ppno":"757\/446-8920","pcpadd":"SUITE 445 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100073,"pcpname":"EVMS Internal Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/363-8612","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":["R92.8","M51.36","M54.5","M19.041","M47.816","Z00.00","Z87.891","M62.549","M79.89","L81.2","R21.","Z12.11","K21.9","Z23.","D50.9","Z88.0","N30.00","E03.9","I10.","Z98.84","R22.0","R76.8","G56.01","M79.641","M62.541","N63.24","N60.02","N63.20","M54.42","J01.90","B96.89","Z98.82","Z12.31","Z01.419","J01.00","Z20.828","H61.23","M65.9","E61.1","K91.2","L40.9","N95.1","R60.9","Z98.0","J32.9","B00.1","Z00.01","Z13.220","M25.552","M47.817","M51.37","M86.9","M89.9","M54.16","E78.5","R79.89","R73.9","D12.0","D12.2","K64.8","J34.2","J34.3","M51.16","M48.061","M51.26","J34.89","M47.26"],"date":["2021-03-17","2021-09-10","2021-09-30","2021-09-17","2021-09-25","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-18","2021-03-18","2021-10-06","2021-06-08","2020-12-17","2021-02-17","2021-02-17","2021-04-28","2021-09-30","2020-01-23","2021-02-02","2021-03-16","2021-03-16","2021-03-29","2021-04-28","2021-04-28","2020-04-13","2020-04-13","2020-04-13","2020-12-17","2020-12-17","2020-12-17","2020-01-23","2020-03-10","2020-01-23","2021-08-12","2021-08-12","2021-10-27","2021-09-16","2021-09-30","2021-09-30","2021-09-17","2021-09-17","2021-09-17","2021-09-30","2021-10-27","2021-09-17","2021-09-17","2021-09-17","2021-09-30","2021-09-25","2021-09-10","2021-09-10","2021-09-10","2021-10-26","2021-09-30","2021-09-30","2021-09-30","2021-10-06","2021-10-06","2021-10-06","2021-10-27","2021-10-27","2021-10-28","2021-09-25","2021-09-25","2021-10-22","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","00046110091","PREMARIN","0.3MG","-5","Select","Select",""],["","69238183207","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","60","Select","Select",""],["","59746038210","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","66685100100","AMOX\/K","875-125","14","Select","Select",""],["","45802005435","TRIAMCINOLON","0.03%","-15","Select","Select",""],["","00591544210","PREDNISONE","10MG","30","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","60","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","90","Select","Select",""],["","57237000299","HYDROCHLOROT ","12.5MG","-90","Select","Select",""],["","00046110091","PREMARIN ","0.3MG","90","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","66685100100","AMOX\/K ","875-125","14","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00591544210","PREDNISONE ","10MG","30","Select","Select",""],["","45802005435","TRIAMCINOLON ","0.03%","15","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","65162010250","GABAPENTIN","300MG","90","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","-90","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","-50","Select","Select",""],["","41100081123","AFRIN ","SPR 0.0005","15","Select","Select",""],["","05928000100","SINUS ","POW KIT","50","Select","Select",""],["","00363070530","SALINE ","SPR 0.0065","30","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}