{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SOFIA  D JONES","gend":1,"add":"5107 DANDY CT APT C","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1983-07-16","age":"","mstatus":"","insh":"8263256*01","cliId":"","pno":7573173199,"cno":7573173199,"email":"","ename":"","eno":"","pphy":"RYAL, JENNIFER L MD","ppno":7574468920,"pcpadd":"SUITE 445 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574465242,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.32","K59.00","Z11.3","S69.92XA","Z23.","B20.","R13.10","E03.9","E11.9","L30.4","J45.909","Z21.","Z79.899","Z88.0","J02.9","H60.391","K80.20","R12.","R11.10","M47.816","M54.16","M96.1","M47.817","R05.9","K22.2","K44.9","K21.9","K29.70","Z13.220","Z01.419","Z20.2","Z97.5","Z30.46","Z32.02","B37.2","N76.0","K02.9","G89.29","NO DATA","M51.36","F31.9","F20.9","D64.9","G40.909","Z82.5","Z79.890","Z13.31","M54.30","M54.9","Z00.00","E66.9","Z86.69","M54.42","Z98.890","M79.2","M62.89","E66.01","K08.89","B86.","L53.9","K29.50","R73.03","E04.9","Z12.4","S62.025A","E83.52","B37.3","Z91.89","R20.8","Z68.42","H92.09","H10.31","R51.9","H92.01","R21.","R19.7","K76.0","R11.2","K31.9","N64.4","R22.0","J01.00","T18.108A","N30.01","B96.89","N89.8","R55.","G47.30","F41.9"],"date":["2021-04-07","2021-04-07","2022-11-17","2021-09-05","2022-09-30","2023-01-10","2023-03-22","2023-04-13","2023-04-13","2022-12-08","2023-03-22","2023-03-22","2023-01-24","2023-01-24","2022-06-20","2022-06-20","2022-10-02","2023-01-17","2023-01-17","2021-11-30","2021-04-30","2021-04-30","2021-04-30","2023-01-06","2023-03-22","2023-03-22","2023-01-24","2023-01-24","2022-05-06","2022-06-06","2021-02-15","2022-06-06","2021-06-02","2021-06-02","2021-06-22","2023-04-01","2022-02-10","2023-04-04","2023-03-22","2021-11-30","2023-03-22","2023-03-22","2021-11-30","2023-04-13","2021-11-30","2023-01-24","2022-11-17","2022-05-03","2023-04-04","2021-02-19","2022-09-30","2021-02-19","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2023-03-22","2022-02-10","2022-08-19","2022-08-19","2023-01-24","2021-12-16","2022-05-03","2021-05-20","2021-09-14","2021-12-16","2022-01-28","2022-02-10","2022-02-10","2023-03-22","2022-06-20","2022-07-29","2022-07-29","2022-07-29","2022-08-19","2022-09-30","2022-10-02","2022-10-02","2023-01-24","2023-04-04","2023-01-12","2023-01-12","2023-01-12","2023-04-01","2023-04-01","2023-04-01","2023-04-13","2023-03-22","2023-03-22"],"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":[["","49702024613","DOVATO","TAB 50-300MG","30","Select","Select",""],["","68180097503","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69238131109","PREGABALIN","CAP 50MG","90","Select","Select",""],["","65862000801","METFORMIN","TAB 500MG","60","Select","Select",""],["","42806001105","SULINDAC","TAB 200MG","60","Select","Select",""],["","61442012101","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","63","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","16571066450","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59676058015","JANSSEN VACC","INJ COVID-19","0","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","14","Select","Select",""],["","68462011940","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","60","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","63481052910","CORTISPORIN","","10","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","49702024213","JULUCA","50 MG-25MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00536127211","ANTIFUNGAL","CRE 0.01","14","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","60","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","21","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","28","Select","Select",""],["","68180097503","LEVOTHYROXINE SODIUM","200 MCG","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":""}]}]}