{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E ANRETNILF ","gend":1,"add":"LARENEG 865DVLB HTOOB ","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1977-10-13","age":"","mstatus":"","insh":"2473110*08","cliId":"","pno":"8275753294","cno":"","email":"","ename":"","eno":"","pphy":"HARDT, ANTHONY B MD","ppno":7573952500,"pcpadd":"1024 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - First Colonial","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":["G36.0","N39.0","Z23.","G24.3","E03.4","E55.9","M85.89","J31.0","J32.0","G03.9","R00.1","R51.9","M35.00","D80.3","E23.6","Z09.","H04.123","M79.672","S92.302D","Z79.52","Z92.241","E53.8","R26.89","M62.81","D89.9","F33.9","F41.9","G25.2","G47.33","H02.403","H46.8","J45.909","L95.0","M62.838","S92.352A","Z87.891","Z88.0","Z88.2","Z88.1","Z91.012","Z91.040","Z88.8","Z91.018","R26.9","Z01.419","N92.0","Z12.31","N95.1","M54.5","R40.0","Z86.018","E16.2","E03.9","F32.A","M54.59","I49.3","R21.","R23.2","Z20.822","G03.0","T50.Z15A","F17.210","I73.00","N31.9","B00.1","Z86.14","Z79.890","Z79.82","I49.5","R42.","H53.149","M47.812","M48.02","M51.36","M43.16","M47.816","R25.1","M50.222","R53.1","H60.543","S92.312A","M25.572","S92.331B","Z79.899","D68.62","M50.322","B02.9","I49.9","G57.62","G35.","R07.9","R06.02","Z86.19","S92.302A","N94.89","Z78.0"],"date":["2023-03-06","2021-04-30","2021-04-09","2021-08-04","2022-10-21","2022-10-21","2022-10-20","2022-01-31","2022-01-24","2022-03-16","2022-05-10","2022-03-16","2023-02-01","2022-02-22","2022-02-22","2022-02-22","2022-12-23","2022-12-06","2022-10-04","2021-03-19","2022-10-20","2022-10-21","2023-03-06","2023-04-18","2023-04-14","2022-09-16","2022-09-16","2023-04-14","2022-09-16","2022-09-16","2022-06-14","2022-09-16","2022-06-14","2023-04-14","2022-07-10","2022-07-10","2022-07-10","2022-07-10","2022-07-10","2022-07-10","2022-07-10","2022-07-10","2022-07-10","2022-07-10","2023-01-26","2023-01-26","2023-01-26","2023-03-29","2021-03-03","2021-11-04","2022-02-10","2021-07-09","2022-02-15","2022-02-15","2023-04-14","2022-03-09","2023-02-01","2023-02-01","2021-11-10","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-09-16","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-02-14","2022-03-16","2022-03-16","2023-01-15","2023-01-15","2023-01-15","2023-01-15","2023-01-15","2023-01-15","2023-01-15","2023-01-15","2022-01-31","2022-08-08","2022-09-06","2022-12-06","2022-12-23","2022-12-23","2021-07-30","2021-08-06","2022-02-13","2022-09-06","2021-07-30","2022-02-15","2022-02-15","2022-03-16","2022-07-11","2023-03-29","2023-03-29"],"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":[["","55111017001","OXAPROZIN","TAB 600MG","60","Select","Select",""],["","31722099910","BACLOFEN","20 MG","360","Select","Select",""],["","53746054501","PRIMIDONE","250 MG","270","Select","Select",""],["","00054474225","PREDNISONE","TAB 2.5MG","30","Select","Select",""],["","16714063301","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","57237015530","MODAFINIL","TAB 200MG","90","Select","Select",""],["","16714061305","SERTRALINE","TAB 100MG","90","Select","Select",""],["","16714069703","VALACYCLOVIR","1000 MG","12","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","50228017905","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","180","Select","Select",""],["","58160088552","FLUARIX","INJ 2020-21","0","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","180","Select","Select",""],["","88888888887","DMR","T ","1","Select","Select",""],["","00378343393","ARMODAFINIL","TAB 250MG","90","Select","Select",""],["","81968035101","SUNOSI","150 MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","14","Select","Select",""],["","31722099910","BACLOFEN TAB","20MG","360","Select","Select",""],["","00591532101","PRIMIDONE TAB","250MG","270","Select","Select",""],["","50242000701","ENSPRYNG","120 MG\/ML","1","Select","Select",""],["","68727035101","SUNOSI TAB","150MG","30","Select","Select",""],["","00172392560","DIAZEPAM","2 MG","90","Select","Select",""],["","10702025301","BUT\/APAP\/CAF TAB","","15","Select","Select",""],["","72647033104","METHYLPRED TAB","4MG","21","Select","Select",""],["","16714061305","SERTRALINE TAB","100MG","90","Select","Select",""],["","65162074510","PROMETHAZINE TAB","12.5MG","30","Select","Select",""],["","51672400105","NORTRIPTYLIN CAP","10MG","30","Select","Select",""],["","50242000701","ENSPRYNG INJ","","1","Select","Select",""],["","88888888887","DMR ADJUSTMENT","","1","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","18","Select","Select",""],["","16714069101","FLUCONAZOLE TAB","100MG","2","Select","Select",""],["","00904693176","PEG","3350 POW","30","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","30","Select","Select",""],["","16714069703","VALACYCLOVIR TAB","1GM","12","Select","Select",""],["","65162046510","IBUPROFEN TAB","600MG","90","Select","Select",""],["","62332025118","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00074929690","SYNTHROID TAB","112MCG","90","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00121086816","NYSTATIN SUS","100000","60","Select","Select",""],["","16714011001","HYDROXYCHLOR TAB","200MG","135","Select","Select",""],["","16714061305","SERTRALINE HCL","100 MG","90","Select","Select",""],["","16714011001","HYDROXYCHLOROQUINE SULFATE","200 MG","135","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":""}]}]}