{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F   HANNAHNOTGNIMER ","gend":1,"add":"AWRETSEW 9085402 TPA LP DL","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1991-09-28","age":"","mstatus":"","insh":"13600210*16","cliId":"","pno":"29\/7578978-0","cno":"","email":"","ename":"","eno":"","pphy":"VANDENHOFF, STEPHEN E MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","Z30.42","I10.","F31.73","R06.00","J80.","E66.01","Z23.","K59.00","R51.","E78.5","Z68.38","T67.5XXA","R00.1","Z30.9","NO DATA","M54.5","G89.29","G43.009","R56.9","I25.2","Z86.73","Z82.0","Z87.891","Z88.1","Z88.2","Z88.8","Z91.030","Z88.7","R51.9","R41.0","M79.601","F06.1","R07.89","R40.4","R55.","R06.2","R94.31","G40.409","G25.81","F25.9","J45.41","J06.9","Z20.822","I49.3","F90.9","Z20.828","Z00.00","F33.1","E78.2","N20.1","N23.","H15.102","M62.830","M54.6","G24.01","F33.2","T65.92XA","R33.9","R10.814","R10.813","R10.2","Z86.69","R10.30","I51.7","R05.9","G43.719","J10.89","S33.5XXA","S63.502A","S63.8X2A","S00.83XA","M54.2","M25.511","M89.8X1","V43.62XA","Y92.488","Y93.89","M54.81","Z87.898","M43.6","G43.909","G40.909","G44.209","R10.11","R11.2","V58.89","Z30.09","J45.909","H04.322","G25.9","T65.91XA","R41.82","R74.8","V62.84","F41.1","F44.81","K21.9","E55.9","Z91.51","Z62.810","Z62.811","I82.611","M79.89","K21.0","K22.9","K44.9","K29.70","Z01.419","K59.09","Z72.0","Z11.1","R53.82","H92.01","Z68.35","R06.02","E86.0","M47.816","M70.61","M70.62","Z91.5","F17.210","I95.1","F43.12","T14.91XA","T51.8X2A","H53.8","H04.123","Z09.","F33.0","R42.","G43.019","Z79.899","S00.03XA","S09.90XA","E87.2","B34.9","F25.0","F60.3","F10.10","F12.21","F11.21","F15.21","Z68.37","F25.1","R23.1","R20.9","M25.611","V89.2XXD","R07.9","J45.901","H92.02","R11.0","R10.84","M25.551","N20.0","G40.319","G43.109","I45.81","T43.505A","F11.20","G44.40","T39.95XA","R19.7","R63.0","R53.83","M25.552","L50.9","T78.40XA","T75.1XXA","F17.290","M70.71","Z32.02","M25.619","E66.09","Z68.33","G93.41","F31.9","F44.9","E78.00","R31.9","K25.7","H54.7","H53.9","S00.93XA","S06.9X1A","Z76.89","K22.10","G43.409","Z11.4","R10.9","R82.90","T50.902A","T52.8X2A","S01.111A","V58.69","Z91.14","S39.012A","G45.9","G93.40","S01.81XA","S01.01XA","M12.9"],"date":["2021-12-30","2021-06-04","2021-12-31","2021-05-03","2020-07-15","2020-07-15","2020-12-08","2021-11-18","2021-06-03","2020-08-26","2021-10-29","2020-08-26","2020-08-27","2021-12-10","2021-06-04","2021-12-25","2021-09-01","2021-07-29","2021-10-25","2021-12-17","2021-12-31","2021-12-31","2021-10-25","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-28","2021-12-31","2021-10-25","2021-12-25","2021-11-12","2021-12-19","2021-12-19","2021-12-25","2021-12-28","2021-12-25","2021-12-25","2021-12-28","2021-12-25","2021-12-25","2021-12-31","2021-12-31","2021-12-31","2021-01-22","2021-12-15","2021-12-25","2021-04-08","2021-12-28","2021-04-08","2021-04-16","2021-04-16","2021-07-21","2021-08-06","2021-08-06","2021-10-30","2021-11-06","2021-11-01","2021-11-07","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-16","2021-12-31","2020-11-18","2020-03-14","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2021-09-10","2020-10-03","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2021-12-15","2020-08-21","2020-08-21","2021-11-24","2021-12-22","2021-11-24","2021-02-01","2021-03-23","2021-03-23","2021-05-12","2021-12-15","2021-07-13","2021-09-11","2021-10-30","2021-11-05","2021-10-30","2021-11-05","2021-12-28","2021-11-05","2021-12-15","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-18","2021-11-12","2020-02-24","2020-02-24","2020-02-26","2020-02-24","2020-01-13","2020-01-30","2020-10-28","2020-10-28","2020-10-28","2020-12-08","2020-12-08","2021-01-16","2021-01-16","2021-06-02","2021-06-02","2021-06-02","2021-07-01","2021-07-01","2021-07-02","2021-10-29","2021-11-05","2021-11-09","2021-11-09","2021-11-09","2021-12-22","2021-11-18","2021-11-18","2021-12-15","2021-11-28","2021-12-17","2021-12-17","2021-12-16","2021-12-28","2020-02-26","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-08-06","2020-01-03","2020-01-10","2020-01-10","2020-09-11","2020-09-11","2020-11-22","2021-12-28","2021-03-29","2021-06-03","2021-04-16","2021-04-20","2021-06-03","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-12-28","2020-02-12","2020-02-12","2021-01-03","2021-01-03","2021-01-03","2021-03-09","2021-03-19","2021-03-19","2021-09-10","2021-11-27","2020-01-28","2020-07-23","2020-09-24","2021-03-08","2021-03-08","2021-10-29","2021-12-15","2021-10-29","2021-12-15","2021-10-29","2021-10-29","2021-11-02","2021-11-04","2021-11-06","2021-12-28","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2021-01-16","2021-08-09","2021-10-29","2021-10-29","2021-12-28","2021-12-28","2021-12-28","2021-08-05","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15"],"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":[["","00406051205","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","00713052612","PROMETHEGAN","SUP 25MG","6","Select","Select",""],["","","ROPINIROLE","TAB 1MG","","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","","LEVETIRACETA","TAB 1000MG","","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","00378110101","PRAZOSIN","CAP 1MG","90","Select","Select",""],["","35573042030","ATOMOXETINE","CAP 80MG","30","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","15","Select","Select",""],["","68382071782","ZOLMITRIPTAN","TAB 5MG ODT","12","Select","Select",""],["","11917013963","B-12","TAB 1000 MCG","2","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","11917016480","LUBRICNT","DRO 0.5% OP","140","Select","Select",""],["","00093227434","AMOX\/K","TAB 500-125","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","33342009441","RIZATRIPTAN","TAB 10MG ODT","12","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","AMPHET\/DEXTR","TAB 20MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","","QUETIAPINE","TAB 100MG","","Select","Select",""],["","65162071310","GUANFACINE","TAB 2MG","90","Select","Select",""],["","17478020919","KETOROLAC","SOL 0.005","3","Select","Select",""],["","00904602576","PEG","POW ","510","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","","LITHIUM","CAP 300MG","","Select","Select",""],["","","SUMATRIPTAN","SPR 20MG\/ACT","","Select","Select",""],["","","CHLORZOXAZON","TAB 500MG","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","BUPROPION","TAB 150MG SR","","Select","Select",""],["","","NICOTINE","DIS 7MG\/24HR","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","SERTRALINE","TAB 25MG","","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","","SUCRALFATE","TAB 1GM","","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":""}]}]}