{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   ENIMSAJNOTELGNIS ","gend":1,"add":"G EVORG 4193H TPA NL ETA","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1987-08-29","age":"","mstatus":"","insh":"1820410*02","cliId":"","pno":"16\/7575599-4","cno":"757\/614-9955","email":"","ename":"","eno":"","pphy":"NURU, YASMIN NP","ppno":"757\/345-4600","pcpadd":"STE 450 400 SENTARA CIR","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"M4","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":["H11.431","H16.141","N76.0","R30.0","N39.3","Z72.51","M54.81","T49.0X5A","Z00.00","M54.5","W57.XXXA","G89.29","T75.4XXA","H65.193","N39.46","R10.2","N94.6","R31.9","N81.11","B34.9","R10.84","R39.89","N89.8","R39.9","Z11.3","J04.0","J20.9","L73.2","M47.816","NO DATA","M17.10","R10.13","R63.0","K29.50","R68.81","R14.2","E66.01","Z71.3","Z68.41","F54.","F33.0","R51.","R52.","I10.","R20.0","G43.109","Z20.822","R10.33","R39.15","R09.1","R79.89","Z98.890","D64.9","Z79.899","Z91.040","R10.30","N93.8","R07.9","B37.3","N81.10","E66.9","H10.33","R15.0","R11.0","E66.3","R51.9","R53.1","H53.8","K21.9","Z01.810","Z01.812","J02.9","R50.9","R68.89","L02.411","H11.433","H18.823","Z20.828","H66.93","H10.9","R19.7","G37.9","J01.00","N81.9","H66.92","R05.1","T15.91XA","N39.41","E66.09","Z98.84","Z68.33","M54.16","Z13.220","E04.9","R07.2","G44.209","M54.6","R42.","N94.10","R11.10","K29.70","R10.9","U07.1","R05.9","H92.09","Z01.818","G43.909","E05.90","Z79.01","Z86.16","J35.8","H18.613","H17.12","Z79.3","E86.0","R79.1","Z68.35","Z87.440"],"date":["2020-02-25","2020-02-25","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2020-08-11","2020-07-14","2020-08-11","2021-01-19","2020-08-11","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2022-04-05","2021-09-28","2021-05-04","2022-08-01","2021-06-17","2021-06-17","2021-10-11","2022-07-26","2022-07-26","2022-07-26","2020-03-01","2020-03-01","2022-05-04","2020-08-31","2022-01-05","2020-08-31","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2022-05-04","2021-11-09","2022-05-04","2021-12-15","2022-01-18","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2021-02-25","2022-07-13","2021-06-15","2021-09-29","2021-10-20","2021-10-20","2022-08-01","2021-10-20","2021-10-20","2022-01-05","2021-10-20","2021-12-17","2022-07-13","2022-03-08","2022-04-05","2022-08-09","2020-01-05","2020-09-02","2022-01-05","2020-09-02","2022-01-05","2020-10-23","2020-10-23","2022-08-09","2021-09-30","2021-09-30","2022-01-05","2022-01-05","2022-01-05","2020-01-07","2020-07-09","2020-07-09","2021-08-04","2020-10-19","2020-10-19","2022-07-13","2020-12-12","2021-02-03","2021-06-08","2021-08-04","2021-10-06","2021-11-27","2022-05-04","2022-08-09","2022-08-09","2022-08-09","2020-07-22","2020-07-22","2020-07-22","2021-10-20","2022-07-13","2022-07-13","2022-07-13","2022-08-01","2020-10-30","2021-02-08","2021-02-08","2022-01-05","2022-01-05","2022-01-05","2022-01-06","2022-05-04","2022-05-04","2022-05-04","2022-05-04","2021-03-01","2021-03-18","2021-03-18","2021-12-17","2022-05-10","2022-07-13","2022-07-13","2022-07-13"],"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":[["","00487930103","SOD","NEB 0.009","300","Select","Select",""],["","55111014601","FLUCONAZOLE","TAB 200MG","7","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","28","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00904667840","OXYCODONE","SOL 5MG\/5ML","100","Select","Select",""],["","00003089321","ELIQUIS","TAB 2.5MG","28","Select","Select",""],["","54838011680","SILACE","LIQ 10MG\/ML","280","Select","Select",""],["","00591299801","URSODIOL","TAB 250MG","60","Select","Select",""],["","66490065020","DIASTAT","GEL 2.5M GEL","2","Select","Select",""],["","68682065020","DIAZEPAM","GEL 2.5MG","2","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","20","Select","Select",""],["","65162037110","OXYBUTYNIN","TAB 5MG ER","30","Select","Select",""],["","33342009441","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","8","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","51663000500","OPTIMAL-D","CAP 50000UNT","8","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","60758018805","GENTAMICIN","SOL 0.3% OP","5","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","61314064725","TOBRA\/DEXAME","SUS 0.3-0.1%","2","Select","Select",""],["","00143988915","AMOXICILLIN","SUS 250\/5ML","600","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","49035065082","EQ","TAB 20MG","60","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","68382000514","TOPIRAMATE","CAP 25MG","60","Select","Select",""],["","70156010601","HYOSCYAMINE","TAB 0.125MG","100","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":""}]}]}