{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CATHY DEY","gend":1,"add":"2600 DARLEY LN","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1959-12-22","age":"","mstatus":"","insh":"1707208*01","cliId":"","pno":"757\/619-8029","cno":"757\/619-8029, 757\/619-8029, 757\/606-1300, ","email":"","ename":"","eno":"","pphy":"GENTRY, BARRY C MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVENUE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":100070,"pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.919","J43.9","M81.0","E66.9","Z85.3","Z79.811","Z78.0","R07.9","I21.4","I10.","Z72.0","M50.31","Z79.810","E55.9","R07.89","Z68.1","R07.81","J44.9","Z71.6","C50.911","C50.912","R00.0","I25.2","I42.8","R05.","I49.9","M51.36","Z51.11","J43.2","J47.9","Z90.13","I25.119","I21.A1","F17.210","I25.10","I45.10","K21.9","K58.9","K22.8","I11.9","E78.5","E78.00","E11.9","I73.00","Z20.828","R00.1","R00.2","R63.4","R06.02","M50.30","M47.816","M85.80","I25.111","J44.1","S39.012A","M54.5","M54.2","I20.1","M48.02","F17.200","J40."],"date":["2021-06-14","2020-01-15","2021-01-14","2020-07-22","2021-01-14","2020-07-22","2020-07-22","2020-10-12","2020-10-13","2021-06-14","2021-01-14","2020-11-05","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-04-29","2021-06-14","2021-04-29","2021-04-09","2021-04-09","2020-10-12","2021-04-14","2020-10-21","2020-01-15","2020-10-13","2021-01-21","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2021-06-14","2020-10-12","2020-10-12","2020-10-12","2020-10-13","2021-04-14","2020-10-12","2020-10-12","2020-10-12","2021-04-14","2021-04-14","2020-07-15","2020-10-12","2021-01-21","2021-01-21","2021-01-21","2020-08-20","2020-03-11","2020-07-01","2020-07-01","2020-11-05","2021-04-14","2020-11-05","2021-06-14","2021-04-29"],"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":[["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","30","Select","Select",""],["","68382082701","TAMOXIFEN","20MG","30","Select","Select",""],["","47335067381","DILTIAZEM","360MG ER","-30","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","-10","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","-15","Select","Select",""],["","65862052201","NAPROXEN","500MG","60","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","16714063301","ALENDRONATE","70MG","4","Select","Select",""],["","68382009301","CARVEDILOL","6.25MG","180","Select","Select",""],["","13668010601","ISOSORB","120MG ER","90","Select","Select",""],["","00173068220","VENTOLIN","","-18","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","70677003201","SM","21MG\/24H","28","Select","Select",""],["","27241012502","RANOLAZINE","500MG ER","60","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00781751587","BUDESONIDE","0.25MG\/2","120","Select","Select",""],["","08373410000","AERONEB","","1","Select","Select",""],["","00378932132","WIXELA","250\/50","180","Select","Select",""],["","16714007104","BACLOFEN","10MG","90","Select","Select",""],["","04351044050","AEROECLIPSE","II NEB","1","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00378797052","IPRATROPIUM","0.02%INH","125","Select","Select",""],["","62332025118","AZITHROMYCIN","250MG","6","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","-53","Select","Select",""],["","69238110005","DOXYCYCL","100MG","30","Select","Select",""],["","83490017805","ERAPID","NEBULIZE","1","Select","Select",""],["","00054032756","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","00054001925","PREDNISONE","50MG","4","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}