{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SELETHIA ANDERSON","gend":1,"add":"708 THAYOR ST","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1965-03-15","age":"","mstatus":"","insh":"20060271*01","cliId":"","pno":7576222618,"cno":7576222618,"email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA 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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.9","E66.01","Z68.43","Z12.11","G89.29","NO DATA","M25.561","M25.562","M25.551","M25.552","R26.89","R32.","R15.9","Z79.891","M43.06","J45.909","I10.","J44.9","R26.9","N32.81","R35.1","N39.46","G47.33","R73.03","J98.4","Z23.","M25.511","M54.2","V89.2XXD","F33.3","G47.00","F41.9","M54.9","M25.50","G62.9","U07.1","D12.7","K57.30","K52.9","K22.70","B20.","Z13.31","Z87.891","Z11.3","Z13.220","R06.02","I07.1","E88.81","J30.2","R09.81","G56.03","K63.5","S89.92XA","S89.91XA","S99.911A","R69.","T14.90XA","R06.09","K21.9","Z21.","Z98.42","Z98.41","Z96.1","Z87.828","J41.0","M54.5","M62.838","R53.1","Z20.828","F32.9","G56.00","N18.9","D50.9","Z79.899","Z79.1","R53.83","Z80.0","Z90.49","Z90.710","Z98.51","Z80.41","M25.571","D53.9","J13.","R05.8","M17.10","Z76.5","Z11.1","R05.1","R52.","J06.9","A08.4"],"date":["2022-04-21","2022-09-01","2022-09-01","2021-10-21","2023-03-10","2023-03-10","2023-03-10","2023-03-10","2023-03-10","2023-03-10","2023-03-10","2023-04-21","2023-04-21","2021-12-13","2022-11-17","2023-02-20","2023-03-03","2022-08-16","2022-08-16","2023-01-30","2023-01-30","2023-01-30","2023-02-20","2022-11-17","2022-11-17","2022-11-17","2023-01-19","2023-02-06","2022-12-15","2023-01-17","2023-01-17","2023-01-17","2022-06-09","2021-09-01","2023-03-03","2021-09-22","2021-11-15","2021-11-15","2021-11-15","2023-01-03","2023-03-03","2022-03-04","2023-01-03","2023-03-03","2023-03-03","2023-01-03","2022-10-20","2023-02-06","2023-02-06","2021-02-08","2021-09-16","2021-11-15","2022-05-29","2022-05-29","2022-05-29","2022-12-09","2022-12-09","2023-01-03","2023-03-03","2022-12-09","2022-12-09","2022-12-09","2022-12-09","2023-01-19","2023-01-19","2021-09-13","2021-09-13","2021-09-13","2021-02-27","2021-03-22","2021-09-01","2023-03-03","2021-11-19","2021-11-19","2021-11-19","2021-03-02","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2022-05-29","2022-09-15","2022-11-29","2022-11-29","2021-05-04","2022-05-17","2023-03-03","2022-12-08","2022-12-08","2023-02-27","2023-04-24"],"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":[["","43547034006","RISPERIDONE","0.5 MG","30","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00597008717","ATROVENT HFA","17MCG","12.9","Select","Select",""],["","54629005024","VITAMIN D3","TAB 1000UNIT","60","Select","Select",""],["","65862003660","LAMIVUD\/ZIDO","TAB 150-300","30","Select","Select",""],["","59676056630","PREZISTA","TAB 800MG","30","Select","Select",""],["","45802091939","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","7","Select","Select",""],["","55111072530","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","60","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00054040713","RITONAVIR","TAB 100MG","30","Select","Select",""],["","65862019901","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","69584009350","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00603533821","PREDNISONE","TAB 10MG","12","Select","Select",""],["","62332038231","TEMAZEPAM","30 MG","30","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","70069000701","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00115132019","COLESEVELAM","TAB 625MG","540","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","354","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","33342032780","TRIAMCINOLON","CRE 0.00025","80","Select","Select",""],["","65162070684","AZELASTINE","SPR 0.0015","30","Select","Select",""],["","59676057530","PREZCOBIX","800-150 MG","30","Select","Select",""],["","50428038612","ACETAMINOPHN","TAB 500MG","90","Select","Select",""],["","65862000801","METFORMIN","TAB 500MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","4","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","6","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","68462038630","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","14","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","21","Select","Select",""],["","00904515460","GUAIFENESIN","TAB 200MG","60","Select","Select",""],["","00002223680","TRULICITY","3 MG\/0.5ML","8","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","68180016111","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","42806071505","BENZONATATE","200 MG","30","Select","Select",""],["","78112001104","CHLORASEPTIC","SPR 0.014","177","Select","Select",""],["","33342032780","TRIAMCINOLONE ACETONIDE","0.025 %","80","Select","Select",""],["","45802016000","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","59651021430","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","68382003616","VENLAFAXINE HCL ER","150 MG","30","Select","Select",""],["","65862003660","LAMIVUDINE-ZIDOVUDINE","150-300 MG","30","Select","Select",""],["","00172208380","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","69584009350","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","49702024613","DOVATO","50MG-300MG","30","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","60","Select","Select",""],["","65862000801","METFORMIN HCL","500 MG","30","Select","Select",""],["","54629005024","VITAMIN D","3 25 MCG","60","Select","Select",""],["","69842016847","ACETAMINOPHEN","500 MG","90","Select","Select",""],["","68462038730","SOLIFENACIN SUCCINATE","10 MG","90","Select","Select",""],["","76282067942","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","00067815203","VOLTAREN ARTHRITIS PAIN","1 %","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":""}]}]}