{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANNATTA LASSITER","gend":1,"add":"812 W 35TH ST # 1 623 W 28TH STREET","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1965-05-18","age":"","mstatus":"","insh":"1922962*01","cliId":"","pno":"757\/949-2704","cno":"757\/949-2704","email":"","ename":"","eno":"","pphy":"NEWMAN, ROBERT J MD","ppno":"757\/446-5955","pcpadd":"SUITE 118 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","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":["B20.","K21.9","B18.1","I10.","E55.9","R39.15","V54.12","M25.531","Z87.81","F41.1","S05.02XA","Z21.","Z85.43","F17.210","H57.89","C56.2","F33.2","R22.0","K04.7","Z00.00","R05.","Z85.9","J30.9","S52.571A","Z23.","M25.631","R60.0","F17.200"],"date":["2021-03-03","2021-03-03","2021-03-03","2021-06-24","2021-03-03","2020-08-05","2021-03-11","2021-03-11","2021-03-11","2020-03-11","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2020-05-26","2020-12-20","2021-03-14","2021-03-14","2020-03-05","2020-09-03","2020-03-05","2020-09-03","2020-02-03","2021-03-03","2020-04-20","2020-04-20","2020-06-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","61958210101","ODEFSEY","TAB ","30","Select","Select",""],["","11822315230","LORATADINE","TAB 10MG","30","Select","Select",""],["","00536132594","POLYVINYL","SOL 1.4% OP","15","Select","Select",""],["","43547035410","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","17478006012","ARTIFI","SOL 1.4% OP","15","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","69097096907","LISINOP\/HCTZ","TAB 20-12.5","90","Select","Select",""],["","55111015901","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00093015010","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}