{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EVELYN   L FOGAN","gend":1,"add":"615 RANDOLPH RD APT 93","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1968-01-01","age":"","mstatus":"","insh":"8763720*01","cliId":"","pno":"243-2365","cno":"243-2365","email":"","ename":"","eno":"","pphy":"VALERIO, HERNANI A MD","ppno":"757\/930-0091","pcpadd":"12715 WARWICK BOULEVARD STE M O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","L82.1","L82.0","R20.0","G43.709","R60.0","F41.8","M25.512","G89.29","M25.511","R56.9","R51.9","F51.04","Z79.899","G62.9","Z12.11","Z86.010","K62.1","K57.30","Z98.890","R06.01","G47.00","F31.9","I10.","F17.210","G47.30","R20.2","G43.719","R06.83","G43.809","E66.9","Z68.38","F12.90","Z72.89","G40.909","R26.89","G47.33","S29.9XXA","R07.9","F43.0","V62.84","Z20.822","Z87.19","F41.0","L91.8","M26.629","S30.811A","Z88.0","R53.83","F19.10","R94.01","S20.211A","E04.9","R93.89","M54.5","Q04.8","G90.09","G40.209","T14.90XA","R07.89","T78.40XA","F41.9","J01.90","F12.10","R60.9","R41.82","R55.","Z01.810"],"date":["2021-04-30","2020-02-17","2020-02-17","2022-02-08","2020-10-08","2020-10-08","2020-10-08","2021-12-02","2021-12-02","2021-12-02","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-04-04","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-08-22","2022-06-28","2022-06-22","2022-06-28","2022-06-22","2022-06-22","2021-02-23","2022-03-01","2022-03-01","2020-10-06","2022-04-04","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-04-04","2022-05-01","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2020-01-17","2020-06-23","2020-01-17","2020-01-17","2020-12-02","2020-12-02","2021-02-03","2022-06-30","2022-06-30","2022-06-30","2020-01-21","2021-05-12","2021-08-10","2021-08-10","2022-04-04","2022-04-30","2020-07-08","2022-06-22","2020-05-12","2020-05-12","2020-09-01","2020-12-02","2020-12-23","2022-06-22"],"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":[]},{"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":[["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","15","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","20","Select","Select",""],["","67877025010","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","31722053960","LEVETIRACETA","TAB 1000MG","60","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","11917017023","MELATONIN","TAB 10MG","30","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","60","Select","Select",""],["","69097068105","PREGABALIN","CAP 100MG","120","Select","Select",""],["","61874011530","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","49483060650","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","60505267108","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","28","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","6","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","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":""}]}]}