{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   YMMATTTOCS ENN","gend":1,"add":"DR 32- 2042 TINU TS ","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1958-11-29","age":"","mstatus":"","insh":"0482210*75","cliId":"","pno":"82\/7578914-5","cno":"757\/285-4198","email":"","ename":"","eno":"","pphy":"LUBBE, JASON M DO","ppno":"757\/507-0305","pcpadd":"1950 GLENN MITCHELL DR STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"ACA","lob":"Individual","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":["C34.31","C34.90","J44.9","J93.11","G47.33","Z85.830","Z01.812","R53.83","M16.12","E55.9","M25.50","F41.9","Z76.89","Z45.2","M35.3","M85.851","C34.91","M16.0","J45.20","Z01.419","N90.89","G56.01","G62.0","M79.601","Z47.1","Z96.642","M16.11","M18.11","M54.16","M54.12","J43.9","D64.9","F32.9","M85.80","K76.0","Z79.01","Z85.118","Z87.891","Z91.81","R91.8","Z88.5","M25.552","R26.89","Z01.810","N39.0","Z51.81","I10.","Z08.","Z92.3","Z92.21","J44.1","Z98.890","H81.12","Z99.89","R90.82","C79.51","R73.9","E78.5","R05.9","R06.2","J18.9","N90.4","M19.90","Z11.51","M76.02","E78.2","F32.5","W19.XXXS","Y92.009","Z79.51","Z79.899","R59.0","Z90.2","C34.11","Z51.0","T82.9XXA","Z51.11","K59.00","R11.0","R92.0","R92.8","Z12.31","F41.8","Z83.3","B37.3","Z23.","Z00.00","R51.","R42.","R26.81","D69.6","R07.9","R53.1","D64.81","T45.1X5A","R00.0","D61.810","M12.9","Z82.49","Z80.9","D61.818","R06.02","R05.","K12.30","C78.01","C77.8","Z90.49","C77.1","Z51.12","Z01.411","N95.1","N95.2","Z12.12","R91.1","K52.89","R11.2","J43.8","G47.30","D70.2","C77.0","J98.4","Z85.9","G54.2","M25.512","R12.","R59.9","J40.","R09.89","N94.9","J18.1","R19.7","E86.0","R10.9","D72.829","K12.31","M47.812","M48.02","M79.602","E53.8","R10.84","Z79.890","R20.0","T14.90XA"],"date":["2022-03-22","2021-10-06","2022-03-22","2021-08-10","2022-03-02","2021-08-17","2021-08-19","2021-08-23","2021-08-25","2022-01-13","2022-01-13","2022-03-02","2021-12-08","2022-02-28","2022-01-13","2022-01-13","2022-01-13","2021-09-14","2021-08-09","2022-01-06","2022-01-06","2022-01-19","2022-01-19","2021-05-12","2022-01-19","2022-01-19","2021-10-06","2021-09-02","2021-09-02","2021-09-02","2022-01-25","2022-03-22","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2022-02-22","2021-09-02","2021-12-14","2021-12-14","2021-08-24","2021-05-13","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-08-13","2021-08-13","2021-08-13","2021-12-08","2021-12-08","2022-01-19","2022-03-02","2021-08-17","2021-08-17","2022-01-19","2022-01-19","2021-12-07","2021-12-07","2021-12-28","2022-02-15","2021-08-24","2022-01-06","2022-01-19","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-02-22","2022-02-22","2019-11-29","2020-03-02","2020-06-25","2020-02-21","2020-01-10","2020-03-16","2020-02-03","2020-02-03","2020-03-09","2020-03-09","2020-02-27","2019-01-18","2020-03-02","2019-01-29","2019-10-04","2020-06-02","2019-11-05","2019-11-05","2019-11-05","2020-02-18","2020-03-02","2020-03-02","2020-04-06","2020-03-02","2020-03-02","2020-04-06","2020-03-02","2020-03-02","2020-03-02","2020-03-04","2020-06-16","2020-09-24","2019-02-19","2019-10-14","2019-10-14","2019-11-29","2019-12-02","2020-09-04","2019-01-24","2019-01-24","2019-01-24","2019-01-24","2019-12-02","2020-02-20","2020-02-06","2019-11-29","2020-02-17","2020-04-06","2020-04-14","2020-09-17","2020-09-17","2020-10-08","2020-10-08","2019-03-09","2019-12-09","2019-09-16","2019-09-16","2019-11-04","2020-06-17","2019-02-17","2019-02-17","2019-02-17","2019-02-17","2019-03-04","2020-09-20","2020-09-20","2020-09-20","2020-10-01","2019-02-17","2019-12-02","2020-09-20","2020-09-20"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","11534016501","FOLIC","TAB 1MG","30","Select","Select",""],["","00143962125","CYANOCOBALAM","INJ 1000MCG","-1","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","-30","Select","Select",""],["","13107008301","LORAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00046110511","PREMPRO","TAB 0.3-1.5","84","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","69543038130","OLANZAPINE","TAB 5MG","10","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","300","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","7","Select","Select",""],["","50228018001","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","14","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","28","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","21","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","Select","Select",""],["","58160088552","FLUARIX","INJ 2020-21","0","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","-45","Select","Select",""],["","57237015630","MOXIFLOXACIN","TAB 400MG","10","Select","Select",""],["","62332037931","TEMAZEPAM","CAP 7.5MG","30","Select","Select",""],["","00054455015","METHOTREXATE","TAB 2.5MG","60","Select","Select",""],["","16714063301","ALENDRONATE","TAB 70MG","-12","Select","Select",""],["","16714038801","CEFADROXIL","CAP 500MG","14","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","88888888887","DMR","T ","1","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093506101","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","500","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","0",""," ","400","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","90","Select","Select",""],["","00591207030","LIDO\/PRILOCN","CRE 2.5-2.5%","-30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","120","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","60","Select","Select",""],["","50383008716","GUAIATUSS","SYP 100-10\/5","180","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":""}]}]}