{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON HEEREN","gend":1,"add":"1344 HILLSIDE AVE APT 3","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1946-12-30","age":"","mstatus":"","insh":"20049024*01","cliId":"","pno":7572260971,"cno":7572260971,"email":"","ename":"","eno":"","pphy":"SNELLINGS, JOHN E MD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE SUITE 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I35.0","I25.10","I25.83","Z68.41","NO DATA","E87.5","M54.2","G89.29","I10.","Z00.6","D69.6","E66.9","I12.9","N18.1","I44.7","M19.90","K08.109","R29.6","K59.00","Z28.21","Z79.82","Z79.899","Z95.2","I08.0","N39.3","W19.XXXA","Z20.828","M54.9","Z23.","I34.0","S99.922A","G47.00","R01.1","I50.30","I34.2","R53.81","F32.9","Z09.","M25.561","I35.2","I50.23","I42.9","I50.31","R06.89","I50.9","I50.43","R07.9","I11.0","R09.02","R07.89","I13.0","I95.9","I42.8","E66.2","N18.9","Z98.84","Z88.0","Z79.02"],"date":["2023-04-04","2021-05-04","2021-05-04","2023-03-28","2023-03-28","2022-06-30","2022-04-08","2022-06-30","2022-10-24","2022-10-05","2023-03-28","2022-10-05","2022-10-05","2022-10-05","2023-03-28","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2023-03-28","2023-03-28","2023-04-04","2022-10-24","2023-02-26","2023-01-09","2021-02-08","2022-10-14","2022-10-14","2022-10-26","2021-11-03","2021-11-03","2021-11-03","2022-07-12","2022-10-26","2023-03-24","2021-05-28","2022-10-06","2021-05-28","2022-10-05","2023-03-30","2023-03-30","2023-04-03","2023-03-28","2023-04-04","2023-03-29","2023-03-29","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28"],"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":[]},{"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":[["","65162062750","TRAMADOL HCL","50 MG","120","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","75834010901","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","45802065087","LORATADINE","10 MG","30","Select","Select",""],["","00378623301","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","00115174801","METAXALONE","TAB 800MG","30","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","180","Select","Select",""],["","00781163501","ISOSORB DIN","TAB 5MG","180","Select","Select",""],["","59267102503","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00378539093","DOXEPIN","TAB 3MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","65862035705","CLOPIDOGREL","75 MG","30","Select","Select",""],["","72888000405","METOPROL TAR","TAB 25MG","180","Select","Select",""],["","00574200830","NYSTOP","100000\/G","30","Select","Select",""],["","00378623301","CITALOPRAM HBR","40 MG","30","Select","Select",""],["","00093550456","OLANZAPINE-FLUOXETINE HCL","6MG-25MG","30","Select","Select",""],["","27241021601","CHLORTHALIDONE","25 MG","90","Select","Select",""],["","45963070911","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","68180031909","BUPROPION XL","150 MG","30","Select","Select",""],["","00310621030","FARXIGA","10 MG","90","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","30","Select","Select",""],["","29300041510","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","23155050105","HYDROXYZINE HCL","25 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":""}]}]}