{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLORIA L JONES","gend":1,"add":"351 SAN ANTONIO BLVD APT 7APT7","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1960-01-29","age":"","mstatus":"","insh":"20017295*01","cliId":"","pno":7575025083,"cno":7575025083,"email":"","ename":"","eno":"","pphy":"MALIAKAL, ALVIN MD","ppno":7574468920,"pcpadd":"825 FAIRFAX AVE STE 445,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","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":7574465242,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.818","I10.","E87.6","M19.90","F17.200","E66.01","E11.9","R06.83","Z13.31","M75.41","M17.11","M25.511","M17.12","M25.562","M11.269","M25.561","C50.411","Z17.0","M94.0","R30.0","D57.3","F17.210","E66.9","Z85.3","Z92.3","Z86.19","Z88.0","Z88.1","Z88.8","Z88.6","Z91.040","Z79.84","Z87.440","F41.9","R21.","B07.0","M65.9","V58.89","E11.620","M77.41","M77.42","M79.602","M79.642","R20.0","R20.2","R77.8","M54.2","Z53.29","Z68.39","E11.42","NO DATA","N60.02","B37.3","R49.9","G89.29","M25.462","M17.0","L85.1","Z79.899","H60.509","Z72.0","L30.4","L30.9","L85.3","M79.672","B35.1","D50.0","J04.0","K21.9","G47.33","R09.82","S91.302A","S91.332A","M76.71","J18.9","I73.9","Z23.","E78.00","J30.9","M25.512","M19.071","M19.032","E11.69","Z68.38","M79.671","S93.601A","M62.838","R07.9","H25.13","H11.021","H52.4","J20.0","J02.9","R05.","E11.40","K76.0","H35.033","M12.9","M79.609","R31.9","R06.02","J20.9","R05.2","R07.89","D50.9","M19.011","M75.51","N28.1","Z85.41","N89.8","R10.9","Z68.42","Z86.010","Z20.822","Z20.828","R35.0","I20.9","R00.0","R06.00","R00.2","R60.9","E55.9","M10.9","M25.461","Z01.419","Z11.3","N76.0","R03.0","M54.16","U07.1","R50.9","R53.83","R51.9","R05.9","I11.9"],"date":["2021-01-04","2023-08-09","2022-12-30","2021-06-14","2023-05-24","2021-05-12","2023-08-24","2021-01-04","2021-05-12","2021-01-27","2021-01-11","2021-01-27","2021-05-06","2022-05-06","2021-05-12","2023-09-18","2023-03-20","2023-02-20","2022-03-18","2022-03-18","2022-03-18","2023-08-24","2023-01-15","2023-08-24","2023-01-15","2022-03-18","2023-01-15","2023-01-15","2023-01-15","2023-01-15","2023-01-15","2023-02-15","2022-03-18","2022-04-01","2022-12-30","2022-08-30","2022-08-30","2022-08-30","2023-06-13","2023-06-13","2022-08-30","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-08-07","2023-05-24","2023-03-20","2021-02-17","2021-02-17","2022-05-06","2022-05-06","2021-08-19","2022-10-04","2023-06-26","2021-06-14","2023-02-15","2022-04-04","2022-04-04","2022-04-04","2022-06-28","2023-06-13","2023-02-20","2021-02-02","2023-08-07","2021-02-02","2021-02-02","2022-05-06","2022-05-06","2022-08-30","2022-12-30","2022-08-09","2022-10-07","2023-08-07","2022-10-07","2023-01-06","2022-06-15","2022-06-15","2022-06-15","2023-01-15","2022-06-15","2022-06-28","2023-01-13","2023-08-24","2023-02-15","2023-02-15","2023-02-15","2021-01-14","2021-01-14","2021-01-14","2021-06-09","2023-03-16","2022-01-28","2022-06-15","2022-08-09","2022-12-27","2022-12-27","2023-01-15","2023-01-15","2023-01-15","2021-03-01","2021-08-23","2021-08-23","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2023-03-16","2023-03-16","2021-01-12","2021-01-12","2023-05-24","2023-06-26","2023-08-24","2023-06-26","2023-08-28","2023-08-18","2023-08-07","2023-08-07","2023-09-18","2023-08-09","2023-08-09","2023-08-09","2023-08-09","2023-08-18","2023-08-24","2023-08-24","2023-08-24","2023-08-24","2023-08-24","2023-08-24"],"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":[["","57237000511","FLUCONAZOLE","150 MG","1","Select","Select",""],["","69543025116","VIRTUSSIN AC","LIQ 100-10\/5","120","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","600","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","29300039705","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","55111064505","OMEPRAZOLE","40 MG","180","Select","Select",""],["","56151146004","TRUE METRIX","TES GLUCOSE","100","Select","Select",""],["","68180063709","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","62756014301","METFORMIN","TAB 750MG ER","30","Select","Select",""],["","65702049210","ACCU-CHEK","TES SMART","100","Select","Select",""],["","99073070822","FREESTYLE","TES LITE","100","Select","Select",""],["","56151085050","TRUETRACK","TES ","100","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","42","Select","Select",""],["","00193731025","CONTOUR","TES NEXT","100","Select","Select",""],["","43598032675","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","11822010233","PAIN RELIEF","TAB 500MG","90","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","20","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","65862090801","CELECOXIB","CAP 100MG","60","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","56","Select","Select",""],["","11822490000","VITAMIN D3","CAP 5000UNIT","4","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","00078079975","CIPRODEX","SUS 0.3-0.1%","8","Select","Select",""],["","00904198760","MAPAP","CAP 500MG","60","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","51672130803","CLOTRIM\/BETA","LOT DIPROP","30","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","31722016601","GABAPENTIN","600 MG","90","Select","Select",""],["","11822061283","ARTHRTS PAIN","TAB 650MG","60","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00187540004","JUBLIA","10 %","4","Select","Select",""],["","68462053670","IMIQUIMOD","CRE 0.05","12","Select","Select",""],["","62332025118","AZITHROMYCIN","250 MG","6","Select","Select",""],["","69238106901","POT CHLORIDE","TAB 20MEQ ER","10","Select","Select",""],["","59746017506","PREDNISONE","20 MG","10","Select","Select",""],["","67877056020","CEFPODOXIME","TAB 200MG","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","53746051401","SPIRONOLACTONE","50 MG","30","Select","Select",""],["","65162067684","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","74312015605","VITAMIN D","3 25 MCG","30","Select","Select",""],["","60505258009","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","67877041401","METFORMIN HCL ER","750 MG","30","Select","Select",""],["","29300039705","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","68382009405","CARVEDILOL","12.5 MG","180","Select","Select",""],["","55111017915","TIZANIDINE HCL","2 MG","21","Select","Select",""],["","00121086816","NYSTATIN SUS","100000","600","Select","Select",""],["","55111064501","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","65162067684","AZELASTINE SPR","0.1%","30","Select","Select",""],["","29300039705","AMLODIPINE TAB","5MG","90","Select","Select",""],["","51672129801","KETOCONAZOLE CRE","2%","30","Select","Select",""],["","16729022501","SPIRONOLACT TAB","25MG","90","Select","Select",""],["","62756014301","METFORMIN TAB","750MG ER","30","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","68180063709","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","45802006436","TRIAMCINOLON CRE","0.1%","80","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","30","Select","Select",""],["","51672130803","CLOTRIM\/BETA LOT DIPROP","","30","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","15","Select","Select",""],["","68462053670","IMIQUIMOD CRE","5%","12","Select","Select",""],["","11822061283","ARTHRTS PAIN TAB","650MG","60","Select","Select",""],["","00187540004","JUBLIA SOL","10%","4","Select","Select",""],["","67877056020","CEFPODOXIME TAB","200MG","20","Select","Select",""],["","62332025118","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","59746017306","PREDNISONE TAB","10MG","20","Select","Select",""],["","68180071160","CEFDINIR CAP","300MG","20","Select","Select",""],["","69238106901","POT CHLORIDE TAB","20MEQ ER","10","Select","Select",""],["","31722016601","GABAPENTIN TAB","600MG","30","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","31722070090","LOSARTAN POTASSIUM","25 MG","90","Select","Select",""],["","70752018012","CODEINE-GUAIFENESIN","10-100MG\/5","120","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","20","Select","Select",""],["","67877021620","CEFUROXIME","500 MG","14","Select","Select",""],["","31722015390","VALSARTAN","160 MG","90","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":""}]}]}