{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAIJA   D WILLIAMS","gend":1,"add":"3801 KEELBOAT CIR APT 102","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1997-04-16","age":"","mstatus":"","insh":"3770478*01","cliId":"","pno":"757\/264-0213","cno":"","email":"","ename":"","eno":"","pphy":"WHALEN, RICHARD M MD","ppno":"757\/446-5955","pcpadd":"SUITE 118 825 FAIRFAX AVE","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\/446-5242","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.818","K21.9","E66.01","Z68.43","G47.33","Z99.89","F33.0","F41.1","Z32.01","N76.0","O20.0","B99.9","O41.8X10","O46.8X1","B96.89","L70.9","O26.892","R55.","Z3A.14","L70.0","L40.8","M54.89","V23.89","O34.219","Z3A.30","Z39.1","O13.4","O41.1230","O34.211","O99.844","O99.284","E89.0","E04.2","O99.72","L40.9","Z37.0","Z3A.37","Z87.59","Z86.32","Z83.49","Z83.3","Z82.5","Z82.49","Z20.822","Z03.818","Z01.419","R10.2","Z11.3","F32.2","L74.510","G43.009","G44.209","N39.3","K91.2","E66.9","R11.2","F50.9","G43.911","Z68.38","Z01.411","N94.0","E30.1","Z98.891","Z01.89","O20.8","Z3A.01","Z34.93","O36.8130","Z3A.31","Z34.82","Z34.83","O99.283","E03.9","V23.5","Z3A.34","O26.893","N61.1","R00.0","Z88.1","O87.2","K59.00","M54.5","U07.1","Z98.84","R09.81","Z79.899","L30.9","L21.9","H61.23","R51.","F32.9","O46.91","Z3A.00","F07.81","Z3A.32","Z3A.35","R82.90","T74.21XA","B37.3","N90.89","L73.2","G43.909","O21.0","E07.9","Z3A.17","Z36.9","Z3A.36","J06.9","R11.0","R61.","N30.00","Z78.9","Z68.35","O26.891","N83.202","O46.90","N93.9","R19.8","T83.32XA","Z30.432","R30.0","M13.0","E06.1","Z30.09","R10.84","R19.7","V23.9","Z23.","Z3A.27","O24.419","O35.9XX0","Z3A.33","O91.113","N93.8","R10.30","L81.0","B00.9","Z20.828","G47.00","G47.30","N92.6","N91.2","Z30.430","G89.18"],"date":["2019-04-16","2020-02-17","2019-10-22","2019-10-22","2019-10-22","2019-10-07","2020-11-04","2020-11-04","2020-09-17","2020-09-23","2020-09-17","2020-09-17","2020-09-23","2020-09-23","2020-09-23","2021-07-06","2020-11-11","2020-11-11","2020-11-11","2021-11-23","2021-11-23","2021-02-18","2021-04-26","2021-03-25","2021-03-15","2021-04-22","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-08-13","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-08-13","2021-04-27","2021-04-27","2021-04-27","2021-11-07","2021-11-07","2021-09-07","2021-09-28","2021-09-07","2019-06-28","2019-07-10","2019-08-08","2019-08-08","2019-10-22","2020-04-20","2020-04-20","2020-09-28","2020-02-17","2020-02-17","2020-02-17","2020-07-23","2020-10-07","2020-07-23","2020-07-23","2020-09-10","2020-09-23","2020-09-28","2021-01-05","2021-03-18","2021-03-22","2021-03-26","2021-03-26","2021-04-22","2021-11-16","2021-04-26","2021-04-12","2021-04-20","2021-04-20","2021-04-20","2021-11-18","2021-04-30","2021-04-30","2021-04-30","2021-08-13","2021-11-18","2021-08-13","2021-11-23","2019-03-29","2019-04-03","2019-05-13","2020-02-19","2020-02-19","2020-10-01","2020-10-01","2020-11-15","2021-03-29","2021-04-19","2020-04-07","2019-07-25","2020-06-07","2020-06-07","2021-05-28","2020-09-28","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2021-04-26","2021-08-13","2020-04-20","2019-09-18","2020-07-05","2020-04-20","2020-04-20","2020-09-08","2020-09-08","2020-10-01","2021-09-28","2021-10-25","2021-11-16","2021-11-16","2021-11-16","2020-04-07","2020-04-07","2020-04-07","2020-05-29","2020-05-29","2021-04-26","2021-02-18","2021-02-18","2021-03-29","2021-04-01","2021-04-05","2021-04-20","2021-11-18","2021-11-18","2019-04-03","2021-05-28","2021-12-30","2019-01-18","2019-01-18","2019-02-28","2019-02-28","2021-04-27","2021-04-28"],"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":[["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","51672125902","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","59088081624","LIDOCAINE\/HC","KIT 2-2%","1","Select","Select",""],["","11917018855","MELATONIN","TAB 3MG","30","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","","CEPHALEXIN","CAP 250MG","","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","57629010020","FERROUS","TAB 325MG","30","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","14","Select","Select",""],["","","PRENATAL","TAB 28-0.8MG","","Select","Select",""],["","80681013800","CALCIUM\/D3","TAB 600MG","60","Select","Select",""],["","","AZELAIC","GEL 0.15","","Select","Select",""],["","45802073684","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","64980032430","PROCTOZONE","CRE -HC 2.5%","30","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","10","Select","Select",""],["","","LIDOCAINE","CRE 0.03","","Select","Select",""],["","69618004410","DOCUSATE","CAP 100MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","25","Select","Select",""],["","65649041112","ANUSOL-HC","SUP 25MG","30","Select","Select",""],["","00713063818","CICLOPIROX","CRE 0.0077","90","Select","Select",""],["","57664002397","ISOTRETINOIN","CAP 30MG","60","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","00378661493","AMNESTEEM","CAP 40MG","30","Select","Select",""],["","69238183801","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","00555105686","CLARAVIS","CAP 30MG","60","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","72578008601","DESONIDE","CRE 0.0005","60","Select","Select",""],["","58160084211","BOOSTRIX","INJ ","0","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","30","Select","Select",""],["","60258017101","MAG","TAB 400MG","100","Select","Select",""],["","00832532510","POT  CL MICRO","TAB 20MEQ ER","3","Select","Select",""],["","","HUMIRA","INJ 40\/0.4ML","","Select","Select",""],["","00168020360","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","30","Select","Select",""],["","63304007601","POT  CHLORIDE","TAB 10MEQ ER","7","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","15","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","TYLENOL","TAB 500MG","","Select","Select",""],["","","SUMATRIPTAN","TAB 50MG","","Select","Select",""],["","","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","","BUT\/ASA\/CAFF","CAP ","","Select","Select",""],["","","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","","DAPSONE","GEL 0.075","","Select","Select",""],["","","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","16729021616","SERTRALINE","TAB 50MG","30","Select","Select",""],["","","LIOTHYRONINE","TAB 5MCG","","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","PAIN","TAB 500MG","","Select","Select",""],["","","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","PYRIDIUM","TAB 200MG","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","ERYTHROMYCIN","GEL 0.02","","Select","Select",""],["","","SALEX","SHA 0.06","","Select","Select",""],["","","MONISTAT","KIT COMBO PK","","Select","Select",""],["","","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","00472011720","TRETINOIN","CRE 0.00025","20","Select","Select",""],["","00187516445","RETIN-A","CRE 0.001","45","Select","Select",""],["","49884006501","GLYCOPYRROL","TAB 1MG","60","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","65862019201","FLUOXETINE","CAP 10MG","60","Select","Select",""],["","00955100410","ENOXAPARIN","INJ 40\/0.4ML","3","Select","Select",""],["","42806000501","OXYCODONE","TAB 5MG","17","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","60","Select","Select",""],["","45802048526","FLUOCIN","OIL 0.01% SC","118","Select","Select",""],["","45802039001","TACROLIMUS","OIN 0.0003","60","Select","Select",""],["","00168004160","BETAMETH","LOT 0.001","60","Select","Select",""],["","00096070760","DRYSOL","SOL 0.2","60","Select","Select",""],["","00378511001","PROCHLORPER","TAB 10MG","20","Select","Select",""],["","42192033901","HYOSCYAMINE","SUB 0.125MG","15","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":""}]}]}