{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BELINDA SMITH","gend":1,"add":"819 SMITH ST","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1978-01-18","age":"","mstatus":"","insh":"3658740*01","cliId":"","pno":"757\/975-6135","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":"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":["K43.9","I10.","Z87.891","Z98.51","Z88.6","Z88.0","K42.9","J45.909","F41.9","R05.9","Z20.822","Z87.898","S92.919A","J45.42","D72.829","F17.200","Z86.711","F31.9","J45.50","V58.69","I16.0","G43.909","K21.9","Z91.138","Z79.899","Z88.8","Z82.49","R06.83","G47.00","G47.8","R06.81","R40.0","R09.81","R53.83","J30.9","E66.9","R10.9","Z01.810","R94.31","Z86.718","R06.02","J45.901","K43.0","R06.89","J45.52","K92.1","R11.10","R44.3","F32.9","R35.0","R10.33","Z87.19","J45.21","S99.922A","M54.30","M25.561","M25.562","Z23.","M79.676","R05."],"date":["2020-09-10","2021-12-19","2021-12-19","2020-08-08","2021-12-19","2021-12-19","2020-09-23","2021-12-19","2021-06-21","2021-12-19","2021-12-19","2021-12-19","2020-02-27","2021-06-01","2021-06-01","2021-06-01","2021-12-19","2021-07-23","2021-07-23","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-12-19","2021-12-19","2021-05-29","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-12-19","2021-06-28","2021-06-28","2021-06-28","2020-08-20","2020-09-22","2020-09-22","2021-05-30","2021-05-30","2021-05-31","2020-09-23","2021-12-19","2021-05-30","2021-12-19","2021-12-19","2021-06-21","2021-06-21","2019-09-08","2019-09-08","2019-09-08","2019-06-06","2019-11-27","2019-10-21","2019-10-21","2019-10-21","2019-10-21","2019-12-18","2019-10-08"],"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":[["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","90","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","6","Select","Select",""],["","70677003101","SM","DIS 14MG\/24H","21","Select","Select",""],["","68382013710","LOSARTAN","TAB 100MG","90","Select","Select",""],["","00135019502","NICODERM","DIS 14MG\/24H","14","Select","Select",""],["","00536117201","ACETAMIN","TAB 500MG","30","Select","Select",""],["","59762305102","AZITHROMYCIN","POW 1GM PAK","1","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","","OXYCODONE","TAB 5MG","","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":""}]}]}