{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA  J MCGOWAN","gend":1,"add":"7832 DALLAS ST APT 101","city":"NORFOLK","state":"VA","zip":"23501-9998","dob":"1959-04-02","age":"","mstatus":"","insh":"20043240*01","cliId":"","pno":"757\/389-3113","cno":"757\/389-3113","email":"","ename":"","eno":"","pphy":"TAHHAN, SAMI GEORGES 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":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5242","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F14.10","I87.313","I87.2","J44.9","J96.11","Z99.81","F17.210","NO DATA","R09.02","R91.1","G47.33","F17.209","I50.22","R06.89","R06.00","J44.1","I10.","F41.1","J98.4","J96.21","R60.0","J93.9","C34.11","Z51.0","J01.90","Z72.0","N17.9","G62.9","L40.9","L29.9","B37.0","K64.9","Z00.00","E11.9","N18.9","E78.5","E11.65","I73.9","R76.0","B19.20","I11.0","I50.9","Z79.84","Z79.899","M79.606","R91.8","I83.009","L97.909","D68.62","F17.200","S12.101A","R68.3","J47.9","R06.02","J95.811","C34.91","Z96.89","Z86.79","Z87.891","E11.44","M79.89","G89.29","R53.83","V54.17","T14.90XA","Z09.","Z71.6","I50.33","I74.10","E87.2","F17.290","Z20.822","D64.9","E11.42","F14.90","B18.2","R94.30","J43.1","I74.11","C34.90","R20.2","E11.40","M79.671","R07.81","S09.90XA","S06.9X9A","S12.040A","S82.114A","M54.2","J69.0","J18.9","Z53.21","I87.8","R51.","R07.89","I70.242","L97.222","L97.901","R20.9","W18.12XA","S12.9XXA","S12.100A","Z01.812","R59.0","R73.9","T38.0X5A","Z12.39","L98.499","Z20.828","J96.22","Z79.01","L28.0","S22.029B","E88.89","S12.391A","M53.2X2","F32.9","Z13.9","I27.20","J30.9","T78.40XA","K59.00","L03.90"],"date":["2021-07-27","2021-07-27","2020-06-24","2020-07-07","2021-03-30","2021-03-09","2021-04-07","2021-03-27","2021-04-13","2021-07-19","2021-03-30","2020-11-02","2021-03-29","2020-08-18","2021-03-27","2021-02-17","2021-02-17","2021-02-17","2021-04-07","2021-02-17","2021-02-17","2021-02-17","2021-03-28","2021-07-23","2021-07-23","2020-01-07","2020-06-14","2020-01-07","2020-05-15","2020-07-06","2020-05-15","2020-05-15","2020-05-15","2020-08-24","2021-04-07","2021-03-30","2021-07-19","2020-05-18","2020-06-01","2020-05-28","2020-05-25","2021-02-10","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-06-19","2021-03-30","2021-03-30","2021-07-19","2021-02-09","2020-09-02","2020-10-09","2021-06-06","2021-04-13","2021-03-27","2021-04-13","2021-03-27","2021-03-27","2021-06-10","2020-07-06","2021-07-19","2020-07-06","2020-07-06","2021-01-04","2021-01-04","2021-01-04","2020-09-18","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-03-23","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-12","2021-03-15","2021-04-06","2021-04-07","2020-05-19","2020-05-19","2020-05-19","2020-06-14","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2021-03-30","2021-01-07","2021-03-27","2021-03-30","2020-05-12","2020-05-12","2020-06-01","2020-06-01","2020-06-15","2020-07-15","2020-09-01","2020-09-15","2021-02-09","2021-03-23","2021-05-12","2020-06-15","2020-06-15","2021-02-09","2021-02-09","2021-01-21","2021-02-13","2021-03-09","2020-07-07","2020-09-02","2020-09-02","2021-02-15","2021-02-15","2021-07-19","2021-02-25","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19"],"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":[["","45802047264","HC ","2.5-1%","30","Select","Select",""],["","43547032506","DOXYCYCL ","200MG DR","7","Select","Select",""],["","45802005505","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","00363053311","MUCUS ","20-400MG","60","Select","Select",""],["","63824005632","MUCINEX ","30-600ER","20","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00955101010","ENOXAPARIN ","100MG\/ML","10","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","30","Select","Select",""],["","00597002402","COMBIVENT ","20-100","4","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","62542030117","HYD ","10-8\/5ML","50","Select","Select",""],["","00378718505","METFORMIN ","500MG","60","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","4","Select","Select",""],["","00904530660","BANOPHEN ","25MG","42","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","20","Select","Select",""],["","00085720601","DULERA ","100-5MCG","13","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","60","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","60","Select","Select",""],["","00363032908","WAL-DRYL ","25MG","42","Select","Select",""],["","43598021055","SSD ","1%","50","Select","Select",""],["","67877025520","CEPHALEXIN ","750MG","20","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","120","Select","Select",""],["","66302046760","ADCIRCA ","20MG","60","Select","Select",""],["","13668058130","TADALAFIL ","20MG","60","Select","Select",""],["","66215050130","OPSUMIT ","10MG","30","Select","Select",""],["","00093551798","SILDENAFIL ","20MG","90","Select","Select",""],["","76439036290","L-METHYL- ","B6-B12","90","Select","Select",""],["","00187099445","ZOVIRAX ","5%","5","Select","Select",""],["","60452000033","LEVICYN ","DERMAL","240","Select","Select",""],["","00591544305","PREDNISONE ","20MG","8","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","45802004475","ACYCLOVIR ","5%","5","Select","Select",""],["","13925015903","LIDOCAINE ","3%","85","Select","Select",""],["","51991001406","MELATONIN ","3MG","20","Select","Select",""],["","00363058714","ASPIRIN ","81MG EC","60","Select","Select",""],["","61958080101","LETAIRIS ","5MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","3","Select","Select",""],["","10135012310","ACETAMIN ","325MG","30","Select","Select",""],["","42799012001","BUMETANIDE ","1MG","180","Select","Select",""],["","43598044874","NICOTINE ","21MG\/24H","28","Select","Select",""],["","00378427093","AMBRISENTAN ","5MG","30","Select","Select",""],["","00904645760","DOK ","100MG","30","Select","Select",""],["","62037055901","POT  CHLORIDE","8MEQ ER","60","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","16729014517","QUETIAPINE ","25MG","60","Select","Select",""],["","23155050001","HYDROXYZ ","10MG","30","Select","Select",""],["","00363010412","PAIN ","325MG","30","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","90","Select","Select",""],["","11917004964","PETROLEUM ","","368","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","00135051101","NICORETTE ","4MG MINT","72","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00904699860","DOCUSATE ","100MG","90","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":""}]}]}