{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L  EINNORYNNED EE","gend":0,"add":"LRAP S 903RD TNEMAI","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1970-08-30","age":"","mstatus":"","insh":"2812210*23","cliId":"","pno":"9475705159","cno":7577149361,"email":"","ename":"","eno":"","pphy":"LAW, KATHERINE P MD","ppno":7574137600,"pcpadd":"5320 PROVIDENCE #301","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23464-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","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":["M77.11","G43.009","G44.221","Z11.59","E78.1","I10.","M51.36","M54.6","M79.10","Z79.899","G44.209","M54.50","J01.00","Z20.828","M17.11","B07.0","Z00.00","H10.13","G43.801","E78.5","K21.9","R73.9","Z12.5","E66.9","Z12.11","M79.7","M54.9","K63.5","K55.20","F31.81","F98.8","F32.9","M54.5","Z20.822","J18.9","R05.1","Z01.810","Z01.812","R94.31","R00.8","I49.3","M17.0","M17.12","G43.901","Z88.8","Z91.011","R20.2","Z23.","M25.521","M25.561","M25.562","G89.29","M22.2X1","M22.2X2","M25.569","M25.50","K42.9","R29.898","R79.89"],"date":["2023-01-18","2022-02-02","2021-08-06","2022-08-22","2023-05-02","2023-05-02","2023-05-19","2023-05-19","2023-05-19","2023-02-27","2022-02-02","2022-05-06","2022-05-21","2022-05-21","2022-07-20","2022-08-11","2023-05-02","2022-08-22","2023-05-02","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-05-28","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-08-06","2021-10-01","2021-10-21","2021-10-21","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2023-05-24","2022-10-25","2021-01-25","2021-01-25","2021-01-25","2021-09-07","2021-09-07","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2023-05-24","2023-05-24","2023-05-02","2023-05-02","2023-05-02","2023-05-02","2023-05-30"],"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":[["","33332031801","AFLURIA","INJ PF 18-19","0","Select","Select",""],["","29300039805","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","16714079801","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","10370010103","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","69097012303","TOPIRAMATE","50 MG","60","Select","Select",""],["","31722099701","HYDROCO\/APAP","TAB 10-325MG","60","Select","Select",""],["","59417010310","VYVANSE","CAP 30MG","30","Select","Select",""],["","00093768432","OLOPATADINE","SOL 0.002","2","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","42195095510","BUT\/APAP\/CAF","CAP ","18","Select","Select",""],["","52937000120","VASCEPA","CAP 1GM","60","Select","Select",""],["","00054050823","ICOSAPENT","CAP 1GM","60","Select","Select",""],["","31722093612","OMEGA-3-ACID","CAP 1GM","120","Select","Select",""],["","65862060012","RIZATRIPTAN","10 MG","9","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","29300039805","AMLODIPINE TAB","10MG","90","Select","Select",""],["","31722099701","HYDROCO\/APAP TAB","10-325MG","120","Select","Select",""],["","31722093612","OMEGA-","3 ACID ETHYL ESTERS 1 G","360","Select","Select",""],["","65862060012","RIZATRIPTAN TAB","10MG","9","Select","Select",""],["","69097012303","TOPIRAMATE TAB","50MG","60","Select","Select",""],["","50742031550","BETAMETH VAL AER","0.12%","50","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","90","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","90","Select","Select",""],["","42571016242","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","51224001060","BENZONATATE CAP","100MG","15","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","58602000739","OLOPATADINE SOL","0.2%","5","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","00527143501","METAXALONE","800 MG","60","Select","Select",""],["","00406012501","HYDROCODONE-ACETAMINOPHEN","10MG-325MG","60","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","90","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":""}]}]}