{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GERALDINE PITTMAN","gend":1,"add":"7246 OAKMONT DR APT A3","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1957-04-29","age":"","mstatus":"","insh":"20041602*01","cliId":"","pno":"757\/961-4425","cno":"757\/961-4425","email":"","ename":"","eno":"","pphy":"MANSER, THOMAS MD","ppno":"757\/446-8920","pcpadd":"825 FAIRFAX AVE SUITE 445","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100073,"pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/964-4405","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-2651","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","G62.9","Z87.891","E78.5","G93.41","N10.","K12.1","M62.81","M79.605","M79.604","N39.3","Z23.","F41.9","F32.9","K13.21","I10.","Z00.00","I73.9","I25.10","I25.82","K90.49","K04.7","J02.9","E11.42","B35.1","R94.39","D64.9","K21.9","I65.29","Z96.651","Z96.652","M17.0","R07.9","R42.","F17.200","N39.0","E87.1","H40.013","H25.13","E78.00","K12.30","M54.2","M27.2","I49.1","G89.29","I25.2","Z98.84","Z86.73","R41.82","R69.","I11.0","I50.9","G47.00","M19.90","F17.210","Z79.84","Z79.01","Z13.31","Z13.9","M20.12","M20.11","M20.41","B35.4","R26.2","M25.552"],"date":["2021-06-03","2020-08-19","2021-06-03","2021-06-03","2020-12-07","2020-12-01","2021-06-16","2020-03-10","2020-03-10","2020-03-10","2020-05-12","2020-10-15","2021-07-13","2021-07-13","2021-08-16","2021-06-03","2020-06-01","2021-06-03","2021-06-03","2021-06-03","2021-03-09","2021-03-09","2021-03-09","2021-08-24","2020-07-30","2020-11-18","2021-06-03","2020-12-01","2020-07-22","2020-08-25","2020-08-25","2020-08-25","2020-10-15","2020-11-02","2020-12-01","2020-12-07","2021-06-03","2021-02-10","2021-02-10","2020-11-10","2021-05-10","2021-05-03","2020-10-12","2020-11-16","2020-12-07","2020-12-01","2020-12-01","2020-12-07","2020-12-01","2020-12-01","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2021-05-10","2021-05-10","2021-08-24","2021-08-24","2021-08-24","2021-09-03","2021-10-04","2021-10-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[["","00187540004","JUBLIA ","10%","4","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","90","Select","Select",""],["","51991029301","OXCARBAZEPIN ","300MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","30","Select","Select",""],["","00093816501","QUETIAPINE ","400MG","90","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","69097083512","SERTRALINE ","100MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","30","Select","Select",""],["","65702071110","ACCU-CHEK ","GUIDE","50","Select","Select",""],["","43598029290","PREGABALIN ","50MG","60","Select","Select",""],["","59779060027","CVS ","81MG EC","30","Select","Select",""],["","65702028810","FASTCLIX ","LANCETS","102","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","270","Select","Select",""],["","50924097110","SOFTCLIX ","LANCETS","200","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","1","Select","Select",""],["","00093681773","BUDESONIDE ","1MG\/2ML","120","Select","Select",""],["","00536123441","ASPIRIN ","81MG EC","90","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","15","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","28","Select","Select",""],["","65862053820","LEVOFLOXACIN ","750MG","4","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","71930005552","APAP\/CODEINE ","300-30MG","20","Select","Select",""],["","10006073027","ZINC ","220MG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00093321915","KETOCONAZOLE ","2%","15","Select","Select",""],["","50111056001","TRAZODONE ","50MG","180","Select","Select",""],["","30768019941","VITAMIN ","50MCG","90","Select","Select",""],["","00093816501","QUETIAPINE","400MG","30","Select","Select",""],["","68180051703","LISINOPRIL","40MG","30","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00093720198","PRAVASTATIN","20MG","30","Select","Select",""],["","51991029301","OXCARBAZEPIN","300MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","59779060027","CVS","81MG EC","30","Select","Select",""],["","65702071110","ACCU-CHEK","GUIDE","50","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","00187540004","JUBLIA","10%","4","Select","Select",""],["","69097083512","SERTRALINE","100MG","30","Select","Select",""],["","43598029290","PREGABALIN","50MG","60","Select","Select",""],["","65702028810","FASTCLIX","LANCETS","102","Select","Select",""],["","69097094312","GABAPENTIN","300MG","270","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","28","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","15","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","90","Select","Select",""],["","33342002332","LEVOFLOXACIN","750MG","4","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00116200116","CHLORHEX","0.12%","1","Select","Select",""],["","10006073027","ZINC","220MG","30","Select","Select",""],["","00093681773","BUDESONIDE","1MG\/2ML","120","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","50111056001","TRAZODONE","50MG","180","Select","Select",""],["","30768019941","VITAMIN","50MCG","90","Select","Select",""],["","68462018147","CLOTRIMAZOLE","1%","45","Select","Select",""],["","50428033847","ITCH","2-0.1%","84","Select","Select",""],["","00168000680","TRIAMCINOLON","0.10%","80","Select","Select",""],["","71930005552","APAP\/CODEINE","300-30MG","20","Select","Select",""],["","00093321915","KETOCONAZOLE","2%","15","Select","Select",""],["","50924097110","SOFTCLIX","LANCETS","200","Select","Select",""],["","00536105227","PEG3350 ","POW ","510","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","4","Select","Select",""],["","00904678744","MAG ","SOL LEMON","296","Select","Select",""],["","00168000680","TRIAMCINOLON ","OIN 0.001","80","Select","Select",""],["","68462018147","CLOTRIMAZOLE ","CRE 0.01","45","Select","Select",""],["","50428033847","ITCH ","CRE 2-0.1%","84","Select","Select",""],["","00904674860","BISACODYL ","TAB 5MG EC","2","Select","Select",""],["","57896048930","POLYETH ","POW 3350 NF","510","Select","Select",""],["","49884068901","METOCLOPRAM ","TAB 10MG","2","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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","",""],["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":""}]}]}