{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES  D SHAW","gend":0,"add":"1725 WOODMILL ST","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1961-11-26","age":"","mstatus":"","insh":"20038334*01","cliId":"","pno":7574103889,"cno":7574103889,"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":["E11.65","E78.5","I10.","R80.9","E11.9","Z87.891","I25.10","F17.200","Z23.","B20.","J44.9","Z82.49","R21.","F17.210","Z72.0","R07.89","I11.0","I51.9","B18.2","Z00.00","M25.561","K74.60","N28.1","Z88.2","Z91.011","G47.33","Z78.9","R06.02","J44.1","J18.9","R09.02","R06.09","J02.9","R91.8","E66.01","J96.01","J20.5","E66.2","E11.8","J96.02","Z68.35","B18.1","B33.8","G47.00","K21.9","K50.90","Z68.41","E66.9","Z20.822","Z80.0","Z83.3","Z88.8","Z91.018","S82.024A","R94.31","I11.9","H35.369","H35.033","H25.13","K63.5","B19.20","Z21.","Z09.","M62.81","Z99.81","R00.2","G47.21","L23.9","Z01.812","K05.00","R39.9","J45.909","J21.0","L30.9","R36.1","R31.29","Z13.31","K42.9","R07.9","B97.4","J44.0","T38.0X5A","E73.9","R19.7","Z12.11","Z83.71","NO DATA","J00.","R00.0","Z12.2","N40.0","R68.82","N52.8","Z12.5","V54.16"],"date":["2022-11-24","2022-11-24","2023-06-07","2021-02-01","2023-03-28","2023-04-17","2022-10-05","2022-11-24","2021-07-28","2023-06-07","2023-06-07","2022-04-28","2021-03-24","2022-07-08","2023-02-15","2021-07-25","2021-06-05","2021-06-05","2022-11-23","2022-01-06","2023-06-14","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2023-04-28","2022-09-23","2022-11-23","2022-11-28","2022-11-24","2022-11-24","2022-11-24","2022-06-29","2022-11-23","2023-04-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2023-06-07","2023-02-15","2021-07-28","2022-11-24","2022-11-24","2022-08-11","2022-04-28","2022-11-24","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-11-08","2023-03-28","2023-03-28","2021-01-22","2021-01-22","2021-01-22","2022-01-13","2022-01-13","2023-04-28","2022-05-06","2023-06-14","2022-11-24","2023-01-17","2021-01-07","2021-03-24","2021-04-05","2022-03-22","2022-12-28","2022-10-05","2022-11-28","2021-01-22","2021-09-27","2021-09-27","2022-10-12","2022-10-12","2022-11-23","2022-11-24","2022-11-24","2022-11-24","2022-11-24","2022-12-06","2021-04-07","2021-04-07","2021-04-07","2021-11-04","2023-03-28","2023-04-17","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-06-14"],"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":[["","49702022813","TIVICAY","TAB 50MG","30","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","180","Select","Select",""],["","61958200201","DESCOVY","TAB 200\/25MG","30","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","60","Select","Select",""],["","59676056201","PREZISTA","TAB 600MG","60","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59676057101","INTELENCE","TAB 200MG","60","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","00597015230","JARDIANCE","10 MG","30","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","15","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","43547042309","LOSARTAN\/HCT","TAB 50-12.5","30","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00378064110","PREDNISONE","10 MG","20","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","00093007301","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00054040713","RITONAVIR","TAB 100MG","60","Select","Select",""],["","43386009663","CLOBETASOL","OIN 0.0005","45","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","21","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","50428031180","SALINE NASAL","SPR 0.0065","44","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","354","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","60219172206","ETRAVIRINE","TAB 200MG","60","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","56","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","20","Select","Select",""],["","68180016011","AZITHROMYCIN","250 MG","6","Select","Select",""],["","62542030103","HYD POL\/CPM","SUS 10-8\/5ML","70","Select","Select",""],["","00245531911","KLOR-CON M20","TAB 20MEQ ER","3","Select","Select",""],["","50428029673","CVS ANTACID\/","SUS ANTI-GAS","355","Select","Select",""],["","74312002832","MELATONIN","TAB 1MG","30","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","19515081852","FLULAVAL QUA","INJ 2021-22","0","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","9","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","42","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","60","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","57237011490","ALFUZOSIN","TAB 10MG ER","30","Select","Select",""],["","00173087410","ARNUITY ELPT","INH 100MCG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","30","Select","Select",""],["","00121063800","GUAIFENESIN","SYP DM","118","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","60","Select","Select",""],["","40985027498","CALC 600+D3","TAB MINERALS","60","Select","Select",""],["","58657050508","GG\/DM","SYP 100-10\/5","118","Select","Select",""],["","16714062101","ZOLPIDEM TARTRATE","5 MG","30","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM","20 MG","45","Select","Select",""],["","43547042309","LOSARTAN-HYDROCHLOROTHIAZIDE","50-12.5 MG","30","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","00173060202","FLOVENT DISKUS","100 MCG","60","Select","Select",""],["","11917012699","VITAMIN B-","12 5000 MCG","90","Select","Select",""],["","50428042127","B-","12 5K-100 MCG","30","Select","Select",""],["","00173086910","ANORO ELLIPTA","62.5-25MCG","60","Select","Select",""],["","50428033845","CALCIUM","600-D3 PLUS 600 MG-20","30","Select","Select",""],["","59651021430","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","70010049110","METFORMIN HCL ER","500 MG","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","57237011490","ALFUZOSIN HCL ER","10 MG","30","Select","Select",""],["","00121063800","GUAIFENESIN-DEXTROMETHORPHAN","100-10MG\/5","120","Select","Select",""],["","45802065078","LORATADINE","10 MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00378967130","IPRATROPIUM\/ SOL ALBUTER","","180","Select","Select",""],["","43547042309","LOSARTAN\/HCT TAB","50-12.5","30","Select","Select",""],["","59651021430","AZELASTINE SPR","0.1%","30","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00173086910","ANORO ELLIPT AER","62.5-25","60","Select","Select",""],["","00093007301","ZOLPIDEM TAB","5MG","30","Select","Select",""],["","00054040713","RITONAVIR TAB","100MG","60","Select","Select",""],["","49702022813","TIVICAY TAB","50MG","30","Select","Select",""],["","60219172206","ETRAVIRINE TAB","200MG","60","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","59676056201","PREZISTA TAB","600MG","60","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","30","Select","Select",""],["","61958200201","DESCOVY TAB","200\/25MG","30","Select","Select",""],["","00093720198","PRAVASTATIN TAB","20MG","15","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","42","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","10","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","68180065208","DOXYCYC MONO CAP","100MG","9","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","50428031180","SALINE NASAL SPR","0.65%","44","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","8","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","15","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","60","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","20","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","30","Select","Select",""],["","43598043611","NITROGLYCERN SUB","0.4MG","25","Select","Select",""],["","49884094499","VARENICLINE PAK","0.5X1MG","53","Select","Select",""],["","49884015676","VARENICLINE TAB","1MG","60","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","57237011490","ALFUZOSIN TAB","10MG ER","30","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","4","Select","Select",""],["","62542030103","HYD POL\/CPM SUS","10-8\/5ML","70","Select","Select",""],["","00173087410","ARNUITY ELPT INH","100MCG","30","Select","Select",""],["","70010049110","METFORMIN TAB","500MG ER","60","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","00121063800","GUAIFENESIN SYP DM","","118","Select","Select",""],["","40985027498","CALC","600+D3 TAB MINERALS","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","58657050508","GG\/DM SYP","100-10\/5","118","Select","Select",""],["","55111032101","GLIMEPIRIDE TAB","2MG","60","Select","Select",""],["","43547005103","TADALAFIL","20 MG","30","Select","Select",""],["","57237001401","TAMSULOSIN HCL","0.4 MG","90","Select","Select",""],["","70377002913","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","68180094111","TESTOSTERONE","20.25\/1.25","75","Select","Select",""],["","68180038809","FENOFIBRATE","48 MG","30","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":""}]}]}