{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AYTAKHADHAD","gend":1,"add":"VKROY 012DAOR WEI","city":"YORKTOWN","state":"VA","zip":"23692-9998","dob":"1964-10-25","age":"","mstatus":"","insh":"4422220*03","cliId":"","pno":"7775712573","cno":7577737521,"email":"","ename":"","eno":"","pphy":"GOSWAMI, BIJOYA MD","ppno":7575941803,"pcpadd":"STE 140 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","plan":"OHP","program":"ACA","lob":"Small Group","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":["N81.6","Z01.419","N32.81","R68.82","B37.3","N39.0","R39.14","Z12.11","M51.36","M51.16","K50.00","M47.896","R74.8","G89.29","M47.816","N23.","K50.90","Z90.49","R68.83","H04.123","H01.02A","H01.02B","H35.433","R19.7","R79.89","Z79.890","Z23.","L60.9","H35.363","H04.121","H04.122","M07.60","M17.11","G89.4","M25.541","K76.0","Z68.29","M79.644","Z12.31","E66.3","F41.9","F32.A","Z68.28","M54.5","R41.3","K50.919","F39.","F90.9","R94.5","N95.9","R07.9","R10.12","T14.90XA","R69.","B35.1","R74.01","N95.2","K21.9","R11.2","R73.03","R05.","J47.9","E55.9","E53.8","F32.9","M25.661","M25.662","M25.641","M25.642","Z00.00","M81.0","Z98.890","M07.641","K50.918","Z79.899","K57.30","M51.26","E66.9","N95.1","R53.83","Z13.1","Z13.21","Z13.220","Z78.0","Z87.19","K22.70","K29.40","K90.0","B96.81","S16.1XXA","R10.32","S00.81XA","Z90.710","Z04.1","E78.2","Z12.39","L60.1","M79.641","Z13.820","K20.90","N13.30","R05.3"],"date":["2022-03-30","2021-03-08","2021-03-08","2022-08-15","2021-03-08","2023-02-20","2021-03-08","2021-03-08","2022-05-23","2021-05-28","2023-01-31","2022-05-23","2023-01-16","2022-05-06","2022-05-06","2023-02-20","2023-04-11","2023-02-20","2023-02-20","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2021-03-09","2021-09-13","2021-03-18","2022-09-06","2021-07-12","2021-08-23","2021-08-23","2021-08-23","2021-11-01","2021-09-13","2022-05-23","2021-11-30","2022-01-17","2022-01-17","2022-02-16","2022-09-02","2023-04-11","2022-09-06","2022-09-06","2023-01-16","2021-07-19","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-09-20","2022-08-15","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2022-03-04","2021-10-04","2022-03-30","2023-01-31","2023-01-31","2023-01-31","2021-07-12","2023-04-11","2021-07-12","2021-03-15","2021-09-13","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-09-13","2021-09-13","2021-09-13","2021-05-12","2021-05-12","2021-08-02","2021-05-26","2021-07-07","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-12-10","2021-12-10","2023-02-20","2023-02-23","2023-02-23","2023-02-23","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-09-09","2021-04-28","2021-07-12","2021-11-30","2021-12-10","2023-02-23","2023-02-20","2023-04-11"],"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":[["","23155010405","METFORMIN","TAB 1000MG","180","Select","Select",""],["","57894006103","STELARA","INJ 90MG\/ML","1","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00054040113","DESVENLAFAX","TAB 100MG ER","90","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","59417010610","VYVANSE","60 MG","60","Select","Select",""],["","68180032002","BUPROPN","TAB 300MG XL","90","Select","Select",""],["","45802010901","TRIAMCINOLON","AER 55MCG\/AC","17","Select","Select",""],["","68220011310","LEVSIN\/SL","SUB 0.125MG","40","Select","Select",""],["","43199001101","HYOSCYAMINE","SUB 0.125MG","20","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","65162055610","TEMAZEPAM","CAP 15MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","4","Select","Select",""],["","59762010405","SULFASALAZIN","TAB 500MG DR","374","Select","Select",""],["","00093322555","DICLOFENAC","DIS 0.013","60","Select","Select",""],["","50111033301","METRONIDAZOL","TAB 250MG","30","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","14","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","64011070101","VYLEESI","INJ 1.75\/0.3","0","Select","Select",""],["","72495020210","FEMRING","MIS 0.1MG\/24","1","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","58604021430","ADDYI","TAB 100MG","30","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","43598021040","SSD","CRE 0.01","400","Select","Select",""],["","64764030020","ENTYVIO","INJ 300MG","1","Select","Select",""],["","11917002529","INSULIN","MIS 1ML\/30G","20","Select","Select",""],["","61703035038","METHOTREXATE","INJ 25MG\/ML","2","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","90","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","46","Select","Select",""],["","71403004401","NUVAIL","SOL 0.16","15","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","65862007930","TERBINAFINE TAB","250MG","30","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","90","Select","Select",""],["","00054040113","DESVENLAFAX TAB","100MG ER","5","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","90","Select","Select",""],["","59417010610","VYVANSE CAP","60MG","90","Select","Select",""],["","13668046330","ITRACONAZOLE CAP","100MG","28","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","60","Select","Select",""],["","68180032002","BUPROPN HCL TAB","300MG XL","90","Select","Select",""],["","00591544210","PREDNISONE TAB","10MG","21","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","42","Select","Select",""],["","00713052612","PROMETHEGAN SUP","25MG","6","Select","Select",""],["","70954005930","PREDNISONE PAK","10MG","21","Select","Select",""],["","65862090801","CELECOXIB CAP","100MG","30","Select","Select",""],["","50261011008","IMVEXXY MAIN SUP","10MCG","8","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","43598081115","CETIRIZINE TAB","10MG","90","Select","Select",""],["","43598021040","SSD CRE","1%","400","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","00378427577","VALACYCLOVIR TAB","500MG","14","Select","Select",""],["","00054040122","DESVENLAFAXINE SUCCINATE ER","100 MG","90","Select","Select",""],["","31722072250","LEVOFLOXACIN","500 MG","7","Select","Select",""],["","57237007810","ONDANSETRON ODT","8 MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","21","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","68180032002","BUPROPION XL","300 MG","90","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","60","Select","Select",""],["","00781808926","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00169413212","OZEMPIC","0.25 OR .5","4.5","Select","Select",""],["","00169450514","WEGOVY","0.5MG\/.5ML","6","Select","Select",""],["","00093770198","LEVOCETIRIZINE DIHYDROCHLORIDE","5 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":""}]}]}