{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ECIRTAEBYHCUS B  ","gend":1,"add":"EP 701EVA RA","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1947-03-28","age":"","mstatus":"","insh":"03000910*053","cliId":"9UA3JM1WN00","pno":"83\/7572585-0","cno":"757\/380-5852","email":"","ename":"","eno":"","pphy":"NEGAARD, KRISTIN D MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":700501,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G35.","Z68.32","Z68.31","K52.9","R10.31","M65.332","N64.89","R90.82","H53.2","Z12.31","R06.02","Z87.09","I49.1","I20.9","S63.635A","R29.898","N63.10","E55.9","J45.998","Z13.31","Z00.00","Z68.30","R52.","Z74.3","R73.9","R92.8","R07.9","M50.31","M50.321","M50.322","M50.323","R25.1","R26.81","M47.812","M79.7","E78.5","K90.9","R73.03","J45.909","M79.645","M79.642","Z12.11","Z20.828","R21.","L29.9","K58.9","K21.9","Z79.899","Z88.8","Z88.1","Z91.048","M25.562","M79.605","R92.1"],"date":["2021-08-24","2020-04-14","2020-08-21","2020-04-14","2020-04-14","2020-07-02","2020-09-16","2020-12-31","2021-08-24","2021-09-17","2020-09-27","2020-09-27","2020-09-28","2020-09-28","2020-06-29","2020-06-29","2020-09-11","2021-08-24","2021-08-24","2021-02-25","2021-02-25","2021-08-24","2020-06-29","2020-06-29","2021-02-23","2020-09-16","2020-09-27","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2021-02-17","2021-02-17","2021-02-17","2021-11-19","2021-02-23","2021-02-23","2021-02-23","2021-11-19","2020-06-29","2020-06-29","2021-05-23","2020-09-29","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-08-24","2021-09-01","2021-09-17"],"priorHcc":[null,"","","","","","","",null,null,"","","","","","","",null,null,"","",null,"","","","","","","","","","","","",null,"","","",null,"","","","",null,null,null,null,null,null,null,null,null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","55111039990","LANSOPRAZOLE ","30MG DR","-90","Select","Select",""],["","00456155060","SAVELLA ","50MG","180","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","00378932232","WIXELA ","500\/50","180","Select","Select",""],["","13668001001","CITALOPRAM ","20MG","-90","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","-90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","58160084252","BOOSTRIX ","","0","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0","Select","Select",""],["","00456155060","","50MG","180","Select","Select",""],["","66993058697","FLUTIC\/SALME ","AER 500\/50","180","Select","Select",""],["","00904530660","BANOPHEN ","CAP 25MG","24","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","28","Select","Select",""],["","72647033104","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","20","Select","Select",""],["","10135014924","DIPHENHYDRAM ","CAP 25MG","24","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}