{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH BROWN","gend":1,"add":"306 CONSTITUTION AVE APT 1","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1958-12-05","age":"","mstatus":"","insh":"20042590*01","cliId":"","pno":"757\/404-6815","cno":"","email":"","ename":"","eno":"","pphy":"BRITTON, BRUCE 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","I34.0","R55.","I46.9","R07.9","J96.01","I49.9","I42.9","I21.4","R06.1","I47.2","E03.9","R00.1","I25.10","I50.33","R94.31","Z86.74","Z86.79","Z87.898","Z87.09","I51.81","I50.40","Z95.5","I11.0","G89.4","R53.1","M51.36","M25.50","R41.82","R79.89","E87.5","I10.","I16.0","G93.40","Z45.2","Z74.09","I49.5","E87.6","F41.9","Z11.59","F17.210","K21.9","J45.909","B19.20","H91.90","I95.9","I50.20","V54.16","V58.89","G57.10","D64.9","I50.43","I49.01","I95.1","M25.511","J01.90","M54.9","J44.9"],"date":["2020-07-13","2020-06-15","2020-06-15","2020-06-26","2020-06-26","2020-07-09","2020-06-26","2020-06-27","2020-07-09","2020-06-26","2020-06-27","2020-06-15","2020-06-25","2020-07-06","2020-06-25","2020-06-26","2020-07-09","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-09","2020-07-06","2020-07-06","2020-07-09","2020-07-09","2020-07-09","2020-07-09","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2020-06-17","2020-06-17","2020-06-23","2020-07-09","2020-06-23","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2020-06-26","2020-06-26","2020-06-14","2020-06-15","2020-06-21","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-27","2020-06-21","2020-03-31","2020-03-31","2019-12-03","2019-12-03","2019-12-03"],"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":[["","","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","29300024310","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","","HYDRALAZINE","TAB 50MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","","LEVOTHYROXIN","TAB 88MCG","","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","METOPROL","TAB 25MG","","Select","Select",""],["","","BRILINTA","TAB 90MG","","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","DIAZEPAM","TAB 5MG","","Select","Select",""],["","","EUTHYROX","TAB 88MCG","","Select","Select",""],["","","EFFER-K","TAB 20MEQ","","Select","Select",""],["","","THERA-M","TAB ","","Select","Select",""],["","16714047801","AMOX\/K","TAB 875-125","14","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":""}]}]}