{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFERY M SINGLETON","gend":0,"add":"4108 CAROLINE AVE","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1986-01-03","age":"","mstatus":"","insh":"2359174*01","cliId":"","pno":5617130008,"cno":5617130008,"email":"","ename":"","eno":"","pphy":"HARTUNG, HILLARY M PA","ppno":7574468999,"pcpadd":"SUITE 572 825 FAIRFAX AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Infectious Diseases","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574467922,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.9","G47.00","J30.9","R06.02","E55.9","J30.1","E78.5","R79.89","R73.01","K64.9","K62.89","K62.5","Z21.","Z23.","K63.3","K63.89","F90.2","F33.2","F41.1","K61.1","R93.3","D72.829","B20.","NO DATA","K21.9","R49.0","R50.9","Z20.822","A41.9","R19.7","M54.5","Z11.3","Z13.220","Z00.00","A53.9","F17.200","Z87.891","Z83.3","Z82.49","Z87.898","Z78.9","K92.2","F17.210","Z91.013","R07.9","Z79.899","L02.215","R94.31","J30.89","A60.00","Z86.19"],"date":["2022-11-29","2023-01-24","2022-03-09","2021-05-06","2022-05-09","2023-09-25","2022-02-10","2021-04-22","2022-05-09","2021-08-19","2022-12-01","2021-11-05","2022-12-02","2023-09-06","2022-02-04","2021-11-05","2023-09-27","2023-09-27","2023-01-24","2022-12-02","2022-12-01","2022-12-01","2023-09-06","2022-05-09","2023-07-26","2022-04-25","2022-11-28","2022-11-28","2022-11-29","2021-09-07","2021-09-07","2023-09-06","2021-10-27","2021-10-27","2021-10-27","2023-09-06","2022-02-10","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-09-30","2022-11-29","2022-11-29","2022-11-28","2022-11-29","2022-11-28","2022-11-28","2021-04-08","2021-08-19","2023-09-06"],"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":[["","54092039101","ADDERALL XR CAP","30MG","30","Select","Select",""],["","13668000705","ZOLPIDEM TAB","5MG","30","Select","Select",""],["","00228306111","AMPHET\/DEXTR CAP","30MG ER","30","Select","Select",""],["","49702024613","DOVATO TAB","50-300MG","30","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","90","Select","Select",""],["","67877071712","MESALAMINE CAP","0.375GM","120","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00527150237","AMPHET\/DEXTR TAB","10MG","30","Select","Select",""],["","68180078001","ZOLPIDEM ER TAB","12.5MG","30","Select","Select",""],["","00115180401","HYDROXYZ PAM CAP","50MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","65862019405","FLUOXETINE CAP","40MG","30","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","28","Select","Select",""],["","65862050220","AMOX\/K CLAV TAB","500-125","16","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","16","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","30","Select","Select",""],["","49702024613","DOVATO","50MG-300MG","30","Select","Select",""],["","00115149101","DEXTROAMPHETAMINE-AMPHET ER","30 MG","30","Select","Select",""],["","49483070210","FLUOXETINE HCL","20 MG","90","Select","Select",""],["","00527150237","DEXTROAMPHETAMINE-AMPHETAMINE","10 MG","30","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","13668000705","ZOLPIDEM TARTRATE","5 MG","30","Select","Select",""],["","45802065078","LORATADINE","10 MG","30","Select","Select",""],["","54092039101","ADDERALL XR","30 MG","30","Select","Select",""],["","67877071712","MESALAMINE ER","0.375G","120","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","00228306111","AMPHET\/DEXTR","CAP 30MG ER","30","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","67877071712","MESALAMINE","CAP 0.375GM","120","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","68180078001","ZOLPIDEM ER","TAB 12.5MG","30","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","60","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","16","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","65862050220","AMOX\/K CLAV","TAB 500-125","16","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":""}]}]}