{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHONDA WATSON","gend":1,"add":"1806 W SOUTH ST APT A","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1981-09-27","age":"","mstatus":"","insh":"6290310*01","cliId":"","pno":"757\/667-0281","cno":"757\/667-0281","email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA S 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":["E11.9","K08.89","I10.","F17.210","M54.2","M54.5","J01.90","B97.89","J30.9","Z87.891","F33.1","R82.90","Z11.3","R10.2","H61.23","J45.909","H65.92","J32.9","H93.19","L85.2","R73.03","Z30.9","F32.9","J01.01"],"date":["2020-07-22","2020-09-15","2021-07-14","2021-07-14","2020-10-27","2020-10-27","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2020-07-07","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2021-04-20","2021-07-14","2021-07-14","2021-07-14","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2021-07-12"],"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":[["","69097015807","MELOXICAM ","7.5MG","30","Select","Select",""],["","10702001250","HYDROXYZ ","50MG","30","Select","Select",""],["","50428047777","DAILY ","48.57%","822","Select","Select",""],["","68382097001","CHLORTHALID ","25MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","49884093547","DICLOFENAC ","1%","100","Select","Select",""],["","00555901658","SPRINTEC ","28 DAY","28","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","86790021380","BENEFIBER ","","152","Select","Select",""],["","75826011410","PHENAZOPYRID ","100MG","9","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30","Select","Select",""],["","00536100901","FERROUS ","325MG","90","Select","Select",""],["","59779048601","EAR ","6.50%","15","Select","Select",""],["","00093117410","PENICILLN ","500MG","28","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","20","Select","Select",""],["","50428029449","CVS ","325MG","90","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00904505359","SUDOGEST ","30MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","45802065078","LORATADINE ","10MG","90","Select","Select",""],["","45802005505","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","10702001250","HYDROXYZ","50MG","30","Select","Select",""],["","45802005505","TRIAMCINOLON","0.10%","454","Select","Select",""],["","86790021380","BENEFIBER","","152","Select","Select",""],["","50428047777","DAILY","48.57%","822","Select","Select",""],["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","68382097001","CHLORTHALID","25MG","90","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","30","Select","Select",""],["","75826011410","PHENAZOPYRID","100MG","9","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","00536100901","FERROUS","325MG","90","Select","Select",""],["","42858010301","OXYCOD\/APAP","7.5-325","20","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59779048601","EAR","6.50%","15","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","00093117410","PENICILLN","500MG","28","Select","Select",""],["","50428029449","CVS","325MG","90","Select","Select",""],["","00904505359","SUDOGEST","30MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","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","",""],["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":""}]}]}