{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA   L COCHRAN","gend":1,"add":"3704 SANDPIPER LN","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1958-09-23","age":"","mstatus":"","insh":"1779745*01","cliId":"","pno":"757\/334-7855","cno":"757\/334-7855","email":"","ename":"","eno":"","pphy":"JOHNSON, MCKENNA M MD","ppno":"757\/446-8920","pcpadd":"825 FAIRFAX AVE STE 445","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\/465-7855","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":["D48.5","I10.","F33.9","F41.0","K44.9","K29.70","K21.9","Z87.11","E03.9","Z88.2","Z79.890","Z79.899","R10.13","L57.0","C44.622","R05.","I49.1","R06.02","L41.0","L30.9","L57.8","Z28.21","Z71.9","F41.9","W19.XXXA","Y92.009","M54.5","J40.","R07.9","R00.2","Z72.0","Z23.","E78.5","Z00.00","E66.9","Z87.891","M54.9","M85.80","F32.9","R07.89","M43.8X6","M47.816","R07.81","Z01.812","Z20.822","Z86.010","K29.60","M85.89","G89.29","I37.1","I07.1","Z12.11"],"date":["2020-03-18","2021-05-13","2020-05-11","2020-06-24","2021-01-27","2021-01-27","2021-01-28","2021-01-27","2021-01-27","2021-05-13","2021-01-27","2021-05-13","2021-01-27","2020-06-08","2020-04-20","2021-01-12","2021-05-13","2021-05-13","2020-03-12","2020-04-20","2020-03-12","2020-03-12","2020-04-20","2021-04-07","2020-05-11","2020-05-11","2021-06-14","2020-10-23","2021-05-13","2021-05-13","2021-04-07","2021-04-07","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2020-03-23","2020-03-23","2020-05-11","2020-05-11","2020-05-11","2021-01-25","2021-01-25","2020-10-27","2021-01-27","2021-06-23","2020-07-20","2021-05-13","2021-05-13","2021-08-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"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":[["","00115151866","ESTRADIOL","0.01%","42","Select","Select",""],["","68180096801","LEVOTHYROXIN ","88MCG","90","Select","Select",""],["","69238153204","CLOBETASOL ","0.05%","90","Select","Select",""],["","43547035310","LISINOPRIL ","10MG","30","Select","Select",""],["","64764017590","DEXILANT ","60MG DR","90","Select","Select",""],["","68180063609","ATORVASTATIN ","20MG","30","Select","Select",""],["","00378427593","VALACYCLOVIR ","500MG","30","Select","Select",""],["","62332002231","FLUOXETINE ","10MG","90","Select","Select",""],["","00115151866","ESTRADIOL ","0.01%","42","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","14","Select","Select",""],["","69315090410","LORAZEPAM ","0.5MG","30","Select","Select",""],["","45802006436","TRIAMCINOLON ","0.10%","-80","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","2","Select","Select",""],["","00093101042","MUPIROCIN ","2%","44","Select","Select",""],["","16714008310","HYDROXYZ ","50MG","90","Select","Select",""],["","59762219803","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00378427593","VALACYCLOVIR","500MG","30","Select","Select",""],["","62332002231","FLUOXETINE","10MG","90","Select","Select",""],["","68180096801","LEVOTHYROXIN","88MCG","90","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","64764017590","DEXILANT","60MG DR","30","Select","Select",""],["","43547035210","LISINOPRIL","5MG","-90","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","14","Select","Select",""],["","00093101042","MUPIROCIN","2%","44","Select","Select",""],["","45802006436","TRIAMCINOLON","0.10%","80","Select","Select",""],["","69315090410","LORAZEPAM","0.5MG","30","Select","Select",""],["","59762219803","AZITHROMYCIN","250MG","6","Select","Select",""],["","16714008310","HYDROXYZ","50MG","90","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","69238153204","CLOBETASOL","0.05%","-90","Select","Select",""],["","00172392670","DIAZEPAM","5MG","2","Select","Select",""],["","68180063609","ATORVASTATIN","20MG","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":""}]}]}