{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENYA   P BELLAMY","gend":1,"add":"7615 BONDALE AVE APT 53","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1986-01-04","age":"","mstatus":"","insh":"4732774*01","cliId":"","pno":"757\/502-9705","cno":"757\/502-9705","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":"","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":["G43.111","R53.1","R20.0","G44.40","F34.1","T39.95XA","F44.4","N83.209","K59.00","Z20.828","M54.5","R10.9","I10.","N39.0","G43.109","F32.9","G43.409","Z79.899","G83.24","R20.2","B34.9","R07.9","R29.90","R21.","K21.9","Z87.891","M79.642","G43.709","N83.202","Z11.59","R10.2","S86.911A","M25.461","U07.1","M94.0","G44.209","S03.2XXA","J45.909","M10.9","Z79.1","K08.89","H02.054","N30.01","R10.32","Z53.29","R07.89","R05.","R68.89","J01.90","Z91.018","R06.02","F10.10","R07.82","R51.","I34.8","K62.89","D48.5","L72.0","L82.1","L76.81","Z98.890","N30.00","NO DATA","N89.8","Z90.710","G43.801","R11.2","R29.810","R47.81","E87.6","N76.0","I63.9","Z87.42","Z30.013","Z32.02","M25.512","R10.30","G43.909","R09.89","R29.711","G43.019","B96.89","H54.7","Z90.721","Z86.19","Z98.51","Z82.49","Z82.3","Z86.59","Z97.3","G89.18","Z03.818","R53.81","R11.0","R29.898","J02.9","G43.009","R19.7","R10.84","K64.4","K64.8","S39.012A","Z71.1","B37.3","Z13.31","A54.9","A74.9","F10.920","L50.9","Z87.19","R51.9","K62.5","Z53.21","R94.2","S70.362A","F44.9","L03.116","R93.89","R59.0","N94.9","N28.1","G45.9","R60.9","W57.XXXA","V58.89","W50.3XXD","W57.XXXD","I80.9","R22.32"],"date":["2020-01-18","2021-09-07","2021-02-14","2020-01-18","2020-01-18","2020-01-18","2021-09-07","2021-06-02","2020-09-28","2020-12-15","2021-01-23","2021-07-06","2021-09-14","2021-07-08","2020-01-17","2021-02-14","2020-01-17","2021-06-01","2020-01-20","2020-01-17","2020-03-13","2021-09-22","2020-06-15","2020-07-27","2021-06-01","2020-12-30","2020-09-09","2020-09-09","2021-06-04","2020-09-24","2021-01-27","2020-11-24","2020-11-24","2020-12-13","2021-09-07","2020-12-12","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2021-05-06","2021-05-31","2021-05-31","2021-05-31","2021-08-18","2020-12-04","2020-01-09","2020-03-18","2021-10-28","2021-08-18","2020-06-14","2020-06-14","2020-09-12","2020-06-15","2021-04-06","2021-06-09","2021-06-09","2021-06-09","2021-06-27","2021-06-27","2021-07-06","2020-11-11","2020-03-06","2021-06-01","2020-09-14","2020-09-14","2021-02-14","2021-02-14","2021-02-14","2021-02-27","2021-09-06","2020-10-06","2020-10-06","2020-10-06","2020-03-31","2020-09-12","2021-06-01","2021-01-04","2021-01-03","2021-01-04","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-08","2020-07-09","2020-07-19","2020-07-19","2021-01-03","2021-03-24","2020-01-17","2020-07-19","2020-08-09","2020-09-23","2020-09-23","2020-11-27","2021-02-28","2021-02-28","2020-01-23","2020-03-09","2020-03-09","2020-03-31","2020-05-10","2020-09-23","2021-09-07","2021-04-06","2021-08-07","2021-09-14","2021-09-12","2021-09-14","2021-09-14","2021-07-24","2021-08-18","2021-08-18","2021-08-18","2021-09-06","2021-09-06","2021-09-12","2021-09-19","2021-09-19","2021-09-19","2021-10-28","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,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":[["","68462049776","ZOLMITRIPTAN ","2.5MG","30","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","30","Select","Select",""],["","63824074316","CEPACOL ","5-7.5MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","30","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","17","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","20","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","300","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","21","Select","Select",""],["","50228043605","NAPROXEN ","500MG","20","Select","Select",""],["","69842080601","CVS ","600MG","20","Select","Select",""],["","00904672059","ACETAMIN ","500MG","50","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","6","Select","Select",""],["","51672200306","CLOTRIMAZOLE ","1% VAG","45","Select","Select",""],["","00472173607","MICONAZOLE ","100MG","7","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","57237004705","DIVALPROEX ","250MG DR","60","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","20","Select","Select",""],["","69842048493","ACETAMINOPHN ","500MG","40","Select","Select",""],["","68180012201","CEPHALEXIN ","500MG","28","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","59779048478","PAIN ","500MG","40","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","20","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","11822039240","RA ","2% EX ST","118","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","42494030124","HYDROCORT ","25MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","00363193112","MILK ","400\/5ML","355","Select","Select",""],["","59726016060","SENNA-S ","8.6-50MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","6","Select","Select",""],["","00904645760","DOK ","100MG","17","Select","Select",""],["","45802086866","POLYETH ","3350 NF","30","Select","Select",""],["","00121087316","LACTULOSE ","10GM\/15","720","Select","Select",""],["","68462041820","LIDOCAINE ","5%","35","Select","Select",""],["","57664050658","METOPROL ","25MG","60","Select","Select",""],["","00536116361","MUCUS ","600MG ER","20","Select","Select",""],["","71093014105","METHOCARBAM ","750MG","60","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","6","Select","Select",""],["","00406055201","OXYCODONE ","5MG","15","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","12","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","00363023820","STOOL ","100MG","30","Select","Select",""],["","00904699860","DOCUSATE ","100MG","30","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00115067151","ZOLMITRIPTAN","2.5MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","65862018730","ONDANSETRON","4MG","30","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","30","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","300","Select","Select",""],["","63824074316","CEPACOL","5-7.5MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","20","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","57237004705","DIVALPROEX","250MG DR","60","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","59779048478","PAIN","500MG","40","Select","Select",""],["","59779073041","CVS","7","45","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","10939057133","HYDROCORT","0.50%","28","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","51672127502","CLOTRIMAZOLE","1%","30","Select","Select",""],["","11822039240","RA","2% EX ST","118","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","6","Select","Select",""],["","00363193112","MILK","400\/5ML","355","Select","Select",""],["","59726016060","SENNA-S","8.6-50MG","60","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","65162010150","GABAPENTIN","100MG","21","Select","Select",""],["","45802086866","POLYETH","3350 NF","30","Select","Select",""],["","00121087316","LACTULOSE","10GM\/15","720","Select","Select",""],["","00904645760","DOK","100MG","17","Select","Select",""],["","00904672059","ACETAMIN","500MG","48","Select","Select",""],["","68462041820","LIDOCAINE","5%","35","Select","Select",""],["","00536116361","MUCUS","600MG ER","20","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","12","Select","Select",""],["","71093014105","METHOCARBAM","750MG","60","Select","Select",""],["","51862094205","DIAZEPAM","5MG","6","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","10","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00363023820","STOOL","100MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","20","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","00904699860","DOCUSATE","100MG","30","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","41167005840","ASPERCREME","LIDO 4%","10","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","52565005615","TRIAMCINOLON","0.10%","15","Select","Select",""],["","00472173607","MICONAZOLE","100MG","7","Select","Select",""],["","00093221001","SUCRALFATE","1GM","20","Select","Select",""],["","69842048493","ACETAMINOPHN","500MG","40","Select","Select",""],["","57664050658","METOPROL","25MG","60","Select","Select",""],["","00406055201","OXYCODONE","5MG","15","Select","Select",""],["","52565005615","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","41167005840","ASPERCREME ","PAD LIDO 4%","10","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","",""],["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":""}]}]}