{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IRENE   V LAW-BUTLER","gend":1,"add":"1113 S CARRINGTON CRES APT 1","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1975-05-26","age":"","mstatus":"","insh":"20040299*01","cliId":"","pno":"757\/637-1390","cno":"757\/637-1390","email":"","ename":"","eno":"","pphy":"BAUMGARTEN, MARGARET MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":100340,"pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/405-2924","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":["F33.1","F41.1","M79.673","K59.00","M79.671","F31.5","V62.84","Z68.38","R44.0","F14.90","F10.10","F17.200","F14.20","Z03.818","F10.20","R52.","F14.10","F25.0","F43.10","M25.561","F25.9","F43.12","S90.851A","R07.9","K02.9","K08.89","J45.909","I10.","F17.210","Z79.899","K03.2","G89.4","L93.2","F31.9","F19.959","T50.902A","V62.89","E66.01","Z68.41","Z23.","Z71.6","T40.1X1A","R41.82","M77.41","L85.8","F29.","B18.2","Z88.6","Z88.1","N93.9","M79.89","R06.00","N95.0","M25.562","G89.29","T14.8XXA","N76.0","B96.89","R05.","M34.0","Z01.818","Z01.810","R94.31","G47.00"],"date":["2020-11-10","2021-11-23","2021-09-17","2021-06-14","2020-09-19","2020-11-09","2020-11-06","2020-11-06","2020-11-06","2020-11-09","2020-11-09","2021-09-17","2021-01-06","2020-12-29","2021-11-23","2021-04-04","2021-11-23","2021-11-23","2021-11-23","2021-07-30","2021-11-15","2021-11-15","2020-08-11","2020-12-23","2020-04-25","2020-11-22","2021-09-14","2021-09-14","2020-11-22","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-12-22","2020-09-21","2020-10-28","2020-10-30","2021-07-30","2021-07-30","2020-11-12","2020-11-12","2020-10-28","2020-10-28","2021-10-25","2021-07-07","2020-10-23","2020-11-22","2020-11-22","2020-11-22","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-06-09","2021-06-26","2021-07-30","2021-07-30","2021-07-30","2021-10-25","2021-09-17","2021-09-14","2021-09-14","2021-11-15"],"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":[["","16714045701","QUETIAPINE ","400MG","60","Select","Select",""],["","16714045101","AMITRIPTYLIN ","150MG","30","Select","Select",""],["","68382018205","BUSPIRONE ","15MG","90","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16","Select","Select",""],["","00186037228","SYMBICORT ","80-4.5","7","Select","Select",""],["","00168000480","TRIAMCINOLON ","0.10%","60","Select","Select",""],["","68382080705","TRAZODONE ","150MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","55111068405","IBU ","800MG","20","Select","Select",""],["","57237004105","PENICILLN ","500MG","28","Select","Select",""],["","16714048502","DIVALPROEX ","500MG ER","60","Select","Select",""],["","62011028702","HM ","","510","Select","Select",""],["","10702018950","HYDROCO\/APAP ","5-325MG","6","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","68462019001","NAPROXEN ","500MG","20","Select","Select",""],["","43547028810","BUPROPION ","100MG SR","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","30","Select","Select",""],["","50428032164","ONE ","WOMENS","30","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","14","Select","Select",""],["","16714029904","AMOXICILLIN ","500MG","21","Select","Select",""],["","68462039610","OMEPRAZOLE ","20MG","60","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","6","Select","Select",""],["","62011003202","PAIN ","325MG","20","Select","Select",""],["","68462035594","DICLOFENAC ","3%","100","Select","Select",""],["","10135012301","ACETAMIN ","325MG","20","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","16714047801","AMOX\/K ","875-125","20","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30","Select","Select",""],["","53746046605","IBUPROFEN ","800MG","20","Select","Select",""],["","59762501002","CLINDAMYCIN ","300MG","28","Select","Select",""],["","00904645780","DOK ","100MG","60","Select","Select",""],["","00310027910","SEROQUEL ","400MG","60","Select","Select",""],["","50428231183","MAG ","CHERRY","296","Select","Select",""],["","50428050854","CVS ","","10","Select","Select",""],["","00904053060","TAB-A-VITE ","","30","Select","Select",""],["","68462013701","OXCARBAZEPIN ","150MG","90","Select","Select",""],["","10370010103","BUPROPN ","150MG XL","30","Select","Select",""],["","53489014605","SMZ\/TMP ","800-160","14","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","16714045101","AMITRIPTYLIN","150MG","30","Select","Select",""],["","00186037228","SYMBICORT","80-4.5","7","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","16","Select","Select",""],["","00168000480","TRIAMCINOLON","0.10%","60","Select","Select",""],["","16714045701","QUETIAPINE","400MG","60","Select","Select",""],["","62011028702","HM","","510","Select","Select",""],["","68382080705","TRAZODONE","150MG","30","Select","Select",""],["","57237004105","PENICILLN","500MG","28","Select","Select",""],["","00093100301","BUSPIRONE","15MG","120","Select","Select",""],["","55111068405","IBU","800MG","20","Select","Select",""],["","16714048502","DIVALPROEX","500MG ER","60","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","16714029904","AMOXICILLIN","500MG","21","Select","Select",""],["","68462019001","NAPROXEN","500MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","6","Select","Select",""],["","10702018950","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","16714047801","AMOX\/K","875-125","20","Select","Select",""],["","62011003202","PAIN","325MG","20","Select","Select",""],["","10135012301","ACETAMIN","325MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","59762501002","CLINDAMYCIN","300MG","28","Select","Select",""],["","53746046605","IBUPROFEN","800MG","20","Select","Select",""],["","00310027910","SEROQUEL","400MG","60","Select","Select",""],["","50428231183","MAG","CHERRY","296","Select","Select",""],["","43547028810","BUPROPION","100MG SR","30","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","50428032164","ONE","WOMENS","30","Select","Select",""],["","68462039610","OMEPRAZOLE","20MG","60","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00591024110","LORAZEPAM","1MG","14","Select","Select",""],["","50428050854","CVS","","10","Select","Select",""],["","00904053060","TAB-A-VITE","","30","Select","Select",""],["","10370010103","BUPROPN","150MG XL","30","Select","Select",""],["","68462035594","DICLOFENAC","3%","100","Select","Select",""],["","53489014605","SMZ\/TMP","800-160","14","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","68462013701","OXCARBAZEPIN","150MG","90","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","00904645780","DOK","100MG","60","Select","Select",""],["","68180069706","TRAMADOL ","TAB 100MG ER","20","Select","Select",""],["","66424002101","DIPHENHYDRAM ","CAP 50MG","30","Select","Select",""],["","16714008310","HYDROXYZ ","TAB 50MG","60","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}