{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CINDY DANCY","gend":1,"add":"4522 PORTSMOUTH BLVD","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1962-08-02","age":"","mstatus":"","insh":"20026125*01","cliId":"","pno":"757\/405-6678","cno":"","email":"","ename":"","eno":"","pphy":"BRITTMAN, STANLEY L MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":"","pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I51.7","K59.00","N81.6","R00.2","Z68.41","R55.","E87.6","G43.909","F17.200","K59.09","E78.5","NO DATA","Z12.4","G43.019","R20.2","Z12.39","Z12.31","R07.9","R10.9","R13.10","R12.","Z12.11","G40.019","I50.9","F10.920","R11.2","Z86.59","F10.10","F10.129","I49.9","Z71.6","M62.838","E05.90","F33.2","F33.1","S63.501A","X50.0XXA","Y93.B9","N64.4","K21.9","E55.9","R68.89","D13.0","Z11.52","K44.9","K29.70","R93.3","E66.01","F17.210","Z78.0","Z79.899","Z68.39","Z98.890","Z13.1","G43.719"],"date":["2021-08-25","2022-05-26","2022-05-26","2021-12-06","2022-05-26","2021-09-09","2021-08-03","2021-08-03","2022-05-26","2022-01-04","2022-11-17","2022-11-17","2022-01-04","2021-04-26","2021-04-26","2021-08-23","2021-08-23","2021-09-09","2021-12-29","2022-10-18","2022-05-26","2022-05-26","2021-02-04","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-08-16","2021-08-16","2021-09-23","2021-09-23","2019-08-29","2019-01-24","2019-03-10","2019-03-10","2019-03-10","2019-01-15","2022-03-15","2022-11-17","2022-03-15","2022-10-18","2022-01-10","2022-09-14","2022-09-14","2022-09-14","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-11-17","2022-11-17"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","65649000330","TRULANCE","TAB 3MG","30","Select","Select",""],["","65862001330","SERTRALINE","TAB 100MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00254302802","LUBIPROSTONE","CAP 8MCG","60","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","69452034672","SUMATRIPTAN","TAB 100MG","30","Select","Select",""],["","55111064501","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","946","Select","Select",""],["","64764008060","AMITIZA","CAP 8MCG","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","","ZONISAMIDE","CAP 100MG","","Select","Select",""],["","57896042601","STOOL","CAP 250MG","60","Select","Select",""],["","","DIVALPROEX","TAB 250MG ER","","Select","Select",""],["","51672413101","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","69238106901","POT  CHLORIDE","TAB 20MEQ ER","5","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","5","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","67877021620","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","FLUARIX","INJ 2020-21","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","49884025011","OLANZA\/FLUOX","CAP 6-25MG","30","Select","Select",""],["","43598016630","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","10370010103","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","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":""}]}]}