{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLY BOND","gend":1,"add":"2812 EARLY ST APT C","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1958-04-09","age":"","mstatus":"","insh":"20041663*01","cliId":"","pno":"757\/667-8615","cno":"","email":"","ename":"","eno":"","pphy":"LATIMER, KELLY M MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["H25.12","H25.012","Z96.1","R74.8","B19.20","F10.10","K64.0","Z86.010","R22.1","B02.7","M17.12","F41.9","F31.9","Z86.59","M25.562","Z23.","B18.2","R59.0","J45.909","B02.29","H40.003","G62.9","E66.9","J44.1","Z20.822","R20.8","B95.0","F17.200","Z12.39","Z01.818","N95.0","N84.0","N88.2","N99.71","E78.00","E78.5","K21.9","E55.9","F25.9","Z68.30","M19.90","F17.210","Z86.19","Z88.1","D12.5","D12.0","K64.8","K63.5","K64.9","A59.01","Z01.812","Z12.4","M89.9","F41.1","F33.1","N88.8","N84.1","Z48.89","R10.2","F12.20"],"date":["2022-08-08","2022-08-08","2019-06-18","2022-03-07","2022-03-07","2022-03-07","2022-03-07","2022-07-19","2021-01-14","2020-04-13","2021-05-25","2022-06-01","2022-06-01","2020-08-24","2022-01-18","2020-10-23","2022-03-21","2021-01-14","2022-07-19","2020-05-04","2022-08-08","2020-06-16","2022-06-01","2021-07-19","2021-07-19","2020-04-13","2020-12-08","2022-01-18","2020-12-08","2022-05-25","2022-06-22","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-05-19","2022-05-31","2022-04-01","2022-07-08","2022-04-25","2022-04-25","2022-06-01","2022-06-01","2022-06-22","2022-06-22","2022-04-25"],"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":[["","43386016106","MISOPROSTOL","TAB 200MCG","6","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","","QUETIAPINE","TAB 25MG","","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","68645052154","SERTRALINE","TAB 25MG","30","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","49035030890","PAIN","TAB 500MG","30","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","49035031207","EQ","POW ","238","Select","Select",""],["","31722094201","HYDROCO\/APAP","TAB 7.5-325","14","Select","Select",""],["","57896044101","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","15","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","8","Select","Select",""],["","","ACYCLOVIR","CRE 0.05","","Select","Select",""],["","","ZOVIRAX","CRE 0.05","","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","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":""}]}]}