{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA PENDRY","gend":1,"add":"616 DUDLEY AVE","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1957-06-09","age":"","mstatus":"","insh":"20049314*01","cliId":"","pno":"757\/587-4869","cno":"","email":"","ename":"","eno":"","pphy":"WHITEHURST-DOSS, SUE NP","ppno":"757\/446-8920","pcpadd":"SUITE 445 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-7114","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","I95.9","R11.2","G43.709","F41.9","F33.9","I10.","E11.9","C43.9","F43.10","F43.29","Z63.4","F41.1","Z23.","R87.612","F43.21","Z00.00","R53.83","E78.5","E11.65","Z01.818","H26.9","H25.12","Z13.31","R55.","R51.9","E87.6","G43.901","Z98.890","Z86.79","K52.9","R10.84","Z86.010","Z79.899","M85.80","L71.0","H25.13","D48.5","L82.1","D22.9","G44.89","J02.9","R53.1","R27.9","W19.XXXA","Y92.009","G50.9","R05.","R26.9","G25.2","I67.1","K63.5","K57.90","K64.8","F33.1","R39.9","J40.","R73.9","D36.9","R63.5","S31.809A"],"date":["2021-09-02","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-11-23","2021-10-14","2021-08-30","2021-06-03","2020-07-17","2020-01-03","2021-06-03","2021-10-14","2020-12-09","2021-06-03","2020-10-20","2020-10-20","2021-06-23","2021-03-04","2020-11-03","2020-11-03","2020-11-18","2021-03-04","2021-08-09","2021-08-09","2021-08-09","2021-10-14","2021-08-11","2021-08-11","2021-09-01","2021-09-01","2020-12-21","2021-03-04","2021-03-04","2021-06-23","2020-10-27","2021-07-22","2021-07-22","2021-07-22","2021-11-23","2021-09-29","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2021-11-23","2021-11-23","2021-11-23","2020-12-21","2020-12-21","2020-12-21","2019-10-04","2019-01-22","2019-02-12","2019-08-20","2019-08-20","2019-08-06","2019-05-07"],"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":[["","00781107905","ALPRAZOLAM","TAB 1MG","120","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","90","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","120","Select","Select",""],["","29300033301","CHLORTHALID","TAB 25MG","14","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","31722088530","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","69238145902","POT  CHLORIDE","SOL 0.1","473","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","30","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","21","Select","Select",""],["","55111025660","ZIPRASIDONE","CAP 20MG","120","Select","Select",""],["","70756020312","AMITRIPTYLIN","TAB 50MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","1","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","270","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","11","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","00527409437","BUT\/APAP\/CAF","CAP ","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","15","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","10","Select","Select",""],["","49884072703","DOXYCYC","CAP 100MG","20","Select","Select",""],["","00363010706","WAL-DRYL","CAP 25MG","120","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":""}]}]}