{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TORRIE   D CUFFEE","gend":1,"add":"841 BAGNALL ROAD","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1976-11-12","age":"","mstatus":"","insh":"2729210*01","cliId":"","pno":"757\/576-0721","cno":"757\/576-0721","email":"","ename":"","eno":"","pphy":"LAYNE, MICHAEL MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/355-4201","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L20.9","Z71.9","K63.5","K57.30","K64.8","M54.31","R26.2","M54.16","M71.551","R10.9","R10.32","K57.32","D12.5","K64.9","M25.551","M54.41","K62.89","M70.60","M54.5","Z23.","M54.9","M79.89","S80.10XA","Z87.891","D50.9","M62.830","E27.8","Z90.710","F32.1","K57.90","M79.7","M17.12","Z48.89","S86.019A","Z20.822","Z90.79","Z90.721","R11.2","R19.7","K59.00"],"date":["2021-09-13","2021-09-13","2021-05-25","2021-05-25","2021-05-25","2020-01-16","2020-03-02","2020-03-02","2020-03-02","2021-04-07","2021-09-04","2021-10-07","2021-05-25","2021-05-25","2020-01-19","2020-01-19","2021-04-27","2020-02-07","2020-10-08","2020-10-08","2020-10-06","2021-07-02","2021-07-02","2021-09-05","2020-01-15","2020-01-15","2021-03-23","2021-09-04","2020-01-10","2021-03-23","2021-09-04","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-09-05","2021-09-04","2021-09-04","2021-09-04","2021-09-05"],"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":[["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","6","Select","Select",""],["","00378113401","KETOROLAC ","10MG","20","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","42","Select","Select",""],["","59746017306","PREDNISONE ","10MG","42","Select","Select",""],["","68462019001","NAPROXEN ","500MG","60","Select","Select",""],["","00378905593","LIDOCAINE ","5%","15","Select","Select",""],["","70700010617","CLOBETASOL ","0.05%","60","Select","Select",""],["","00093101042","MUPIROCIN ","2%","44","Select","Select",""],["","68462030065","ALCLOMETASON ","0.05%","60","Select","Select",""],["","68462060965","PIMECROLIMUS ","1%","120","Select","Select",""],["","66993087861","CALCIPOTRIEN ","0.01%","60","Select","Select",""],["","00054455015","METHOTREXATE ","2.5MG","4","Select","Select",""],["","69315012701","FOLIC ","1000MCG","30","Select","Select",""],["","11822489250","FAST ","10MG","16","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","30","Select","Select",""],["","52268020101","SUTAB ","","24","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","90","Select","Select",""],["","00187510102","ELIDEL ","1%","120","Select","Select",""],["","31722094901","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","00781194339","AMOX-POT ","ER","48","Select","Select",""],["","41100056656","MIRALAX ","3350","20","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","58657067601","CIPROFLOXACN ","500MG","20","Select","Select",""],["","65162062710","TRAMADOL ","50MG","20","Select","Select",""],["","68462019001","NAPROXEN","500MG","60","Select","Select",""],["","00378905593","LIDOCAINE","5%","15","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","65162062710","TRAMADOL","50MG","20","Select","Select",""],["","00378113401","KETOROLAC","10MG","20","Select","Select",""],["","59746021106","CYCLOBENZAPR","5MG","42","Select","Select",""],["","59746017306","PREDNISONE","10MG","42","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","50383026860","CLOBETASOL","0.05%","60","Select","Select",""],["","00093101042","MUPIROCIN","2%","44","Select","Select",""],["","68462030065","ALCLOMETASON","0.05%","60","Select","Select",""],["","00054455015","METHOTREXATE","2.5MG","2","Select","Select",""],["","69315012701","FOLIC","1000MCG","30","Select","Select",""],["","66993087861","CALCIPOTRIEN","0.01%","60","Select","Select",""],["","68462060965","PIMECROLIMUS","1%","120","Select","Select",""],["","00187510102","ELIDEL","1%","120","Select","Select",""],["","11822489250","FAST","10MG","16","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","30","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","120","Select","Select",""],["","00781194339","AMOX-POT","ER","48","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","41100056656","MIRALAX","3350","20","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","46581083006","SALONPAS ","PAD 0.04","30","Select","Select",""],["","65162063609","PANTOPRAZOLE ","TAB 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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}