{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT W FLETCHER","gend":0,"add":"5432 TIDEWATER DR S APT 217","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1964-07-03","age":"","mstatus":"","insh":"20067970*01","cliId":"","pno":7578570201,"cno":7578570201,"email":"","ename":"","eno":"","pphy":"MANSER, THOMAS MD","ppno":7574468920,"pcpadd":"825 FAIRFAX AVE SUITE 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":7576222651,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F14.10","F14.20","B20.","R78.81","J18.9","R65.10","T78.40XA","E55.9","G47.33","V62.84","F32.9","I10.","F19.10","Z72.89","F10.20","F12.20","F11.20","R51.9","Z20.822","R50.9","Z74.3","E87.1","Z23.","H40.1132","F17.200","E78.5","F14.90","L91.0","NO DATA","R06.83","F19.20","F33.2","F14.99","Z91.11","H40.029","H25.13","H35.362","H35.363","Z01.89","A41.50","Z88.1","Z79.2","F17.210","E66.9","Z68.34","Z91.19","B35.3","R10.13","Z01.812","I49.9","R07.89","R07.9","R61.","J16.8","N17.9","A41.59","J15.9","Z21.","K21.9","E86.0","Z91.14","H40.1134","G47.10","F33.1","F41.9"],"date":["2022-10-26","2023-03-27","2022-10-26","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-10-26","2022-12-02","2022-06-14","2022-06-14","2022-12-02","2022-06-14","2022-06-14","2022-06-19","2023-03-09","2022-08-24","2022-09-19","2022-09-22","2022-09-21","2022-09-21","2022-09-25","2022-12-02","2022-10-18","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2021-03-10","2021-03-10","2022-01-10","2022-08-19","2022-08-19","2022-08-19","2022-08-19","2022-09-23","2022-09-27","2022-09-27","2022-09-27","2021-03-02","2021-03-02","2021-03-02","2022-09-22","2021-05-11","2021-07-20","2021-02-27","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2022-09-21","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-29","2021-04-09","2023-03-27","2023-03-27"],"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":[["","00597007547","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","43598044874","NICOTINE TD","DIS 21MG\/24H","14","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","70700015001","OMEPRAZOLE","CAP 20MG","28","Select","Select",""],["","00168013315","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","29300039705","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","51672208001","TERBINAFINE","CRE 0.01","15","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","7","Select","Select",""],["","51224002250","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","9","Select","Select",""],["","51672202001","TOLNAFTATE","CRE 0.01","15","Select","Select",""],["","33342006807","OLANZAPINE","TAB 5MG","7","Select","Select",""],["","61269034356","HYDROCORT","CRE 0.01","28","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","19515080852","FLULAVAL QUA","INJ 2022-23","0","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","54629794101","VITAMIN D3","TAB 5000UNIT","28","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","64380080807","IBUPROFEN","600 MG","30","Select","Select",""],["","49483034010","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","80681008500","MELATONIN","3 MG","30","Select","Select",""],["","50111056101","TRAZODONE HCL","100 MG","30","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","30","Select","Select",""],["","00378210001","LOPERAMIDE","2 MG","2","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","30","Select","Select",""],["","00904723760","BANOPHEN","25 MG","2","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","00143993905","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","16729021616","SERTRALINE TAB","50MG","7","Select","Select",""],["","51672202001","TOLNAFTATE CRE","1%","15","Select","Select",""],["","61269034356","HYDROCORT CRE","1%","28","Select","Select",""],["","00536132926","TOLNAFTATE POW","1%","45","Select","Select",""],["","33342006807","OLANZAPINE TAB","5MG","7","Select","Select",""],["","70954005920","PREDNISONE TAB","10MG","9","Select","Select",""],["","59762219807","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","70700015001","OMEPRAZOLE CAP","20MG","28","Select","Select",""],["","67877019990","AMLODIPINE TAB","10MG","30","Select","Select",""],["","55111028130","LEVOFLOXACIN TAB","750MG","7","Select","Select",""],["","54629794101","VITAMIN D","3 TAB 5000UNIT","28","Select","Select",""],["","68180063609","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","00527169501","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","19515080852","FLULAVAL QUA INJ","2022-23","0","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":""}]}]}