{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLY BOND","gend":1,"add":"2812 EARLY ST APT C","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1958-04-09","age":"","mstatus":"","insh":"20041663*01","cliId":"","pno":7576678615,"cno":7576678615,"email":"","ename":"","eno":"","pphy":"LATIMER, KELLY M MD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE STE 118,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574465196,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N95.0","Z12.4","N84.0","N88.2","N88.8","N84.1","R59.0","R22.1","H40.003","H25.12","H25.012","F41.9","B18.2","F41.1","F33.1","F12.20","Z01.812","NO DATA","J44.1","Z20.822","Z01.818","A59.01","Z48.89","R10.2","R74.8","Z86.010","K64.8","B19.20","F10.10","M17.12","K64.0","E78.5","K21.9","F31.9","M25.562","E55.9","F17.200","M89.9","D12.5","D12.0","K63.5","K64.9","J45.909","Z87.891","N99.71","E78.00","F25.9","E66.9","Z68.30","M19.90","F17.210","Z86.19","Z88.1","K64.4","Z91.81"],"date":["2022-06-22","2022-04-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2021-01-14","2021-01-14","2022-08-08","2022-08-08","2022-08-08","2022-06-01","2022-03-21","2023-04-25","2023-04-25","2023-04-25","2022-05-31","2023-04-25","2021-07-19","2021-07-19","2022-05-25","2022-05-19","2022-06-22","2022-06-22","2023-04-12","2023-04-12","2023-04-12","2023-06-14","2023-04-12","2023-06-20","2022-03-07","2022-06-01","2022-06-01","2023-06-20","2022-01-18","2022-06-01","2022-01-18","2022-07-08","2022-07-19","2022-07-19","2022-07-19","2023-06-14","2023-06-14","2023-04-25","2022-06-01","2022-06-01","2023-06-14","2022-06-01","2022-06-01","2023-06-14","2023-06-14","2022-06-01","2022-06-01","2023-06-14","2023-06-20"],"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":[["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","65162019011","NAPROXEN","500 MG","60","Select","Select",""],["","59726019003",""," ","4","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68645052154","SERTRALINE","TAB 25MG","30","Select","Select",""],["","43386016106","MISOPROSTOL","TAB 200MCG","6","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","57896044101","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","49035030890","PAIN RELIEVR","TAB 500MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","31722094201","HYDROCO\/APAP","TAB 7.5-325","14","Select","Select",""],["","49035031207","EQ CLEARLAX","POW ","238","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","31722053401","METHOCARBAMOL","750 MG","60","Select","Select",""],["","27241009803","DULOXETINE HCL","30 MG","30","Select","Select",""],["","68645052254","SERTRALINE HCL","50 MG","30","Select","Select",""],["","68180044501","QUETIAPINE FUMARATE","25 MG","30","Select","Select",""],["","70710171001","KETOROLAC TROMETHAMINE","10 MG","20","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","68180044501","QUETIAPINE TAB","25MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","65162019011","NAPROXEN TAB","500MG","30","Select","Select",""],["","43386016106","MISOPROSTOL TAB","200MCG","6","Select","Select",""],["","00093505698","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","68645052154","SERTRALINE TAB","25MG","30","Select","Select",""],["","49035030890","PAIN RELIEVR TAB","500MG","30","Select","Select",""],["","49035048462","ACETAMINOPHN TAB","500MG","30","Select","Select",""],["","68645056354","IBUPROFEN TAB","800MG","15","Select","Select",""],["","49035031207","EQ CLEARLAX POW","","238","Select","Select",""],["","57896044101","BISACODYL TAB","5MG EC","4","Select","Select",""],["","31722094201","HYDROCO\/APAP TAB","7.5-325","14","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","62559015710","POLYETHYLENE GLYCOL","3350 17 G","100","Select","Select",""],["","42002030268","TUCKS","50 %","100","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":""}]}]}