{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H EITAKSNIKPO","gend":1,"add":"NNERW 747A TPA DR ","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1981-09-16","age":"","mstatus":"","insh":"3492210*09","cliId":"","pno":"07\/7577745-3","cno":"","email":"","ename":"","eno":"","pphy":"GIBSON, RUTH R NP","ppno":"757\/542-2000","pcpadd":"20209 SENTARA WAY STE 200","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - St. Luke's","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","R07.2","Z51.81","Z79.01","G40.309","G40.909","E11.51","I11.9","J45.20","F41.8","E11.42","D64.9","E11.69","E78.5","K59.00","Z79.84","Z79.51","Z86.711","Z86.718","I42.0","Z91.89","K59.04","Z80.9","K62.5","D68.59","Z87.898","R10.814","Z01.89","E66.9","Z79.899","E11.59","F33.9","Z86.010","K64.8","E66.09","R00.0","R94.30","K64.0","R47.01","Z09.","N30.01","G40.901","G40.A01","I83.891","I82.4Z9","R07.9","R56.9","M25.571","I83.811","Z01.84","Z23.","F33.41","Z12.31","N39.41","N39.498","E55.9","I10.","R53.82","E11.9","H16.143","R29.6","G47.00","E11.65","G43.009","K59.09","R19.4","Z91.81","R07.89","R09.02","I26.99","F33.1","I73.9","G44.209","N39.3","B37.3","R31.21","R39.15","N81.11","Z86.69","R94.01","I27.82","I26.09","Z79.4","M79.609","R42.","Z12.4","G57.91","Z63.79","Z00.00","Z28.21","G40.409","I49.3","R32.","E11.43","I83.92","Z87.442","F43.23","G43.909","Z88.8","R41.82","I42.9","E86.0","F41.9","G89.29","J45.40","Z48.817","R79.1","Z97.5","Z47.1","Z86.79","R11.2","I49.1","R00.2","J20.8","B37.9","B96.89","T36.95XA","I82.409","Z87.891","Z82.49","E11.29","R06.02","F33.0","Z51.89","I82.4Z1","R33.9","Z87.440"],"date":["2022-03-10","2022-04-19","2022-10-11","2022-10-11","2022-09-30","2022-04-19","2020-07-06","2020-07-06","2022-03-10","2020-07-06","2022-09-30","2021-08-05","2022-09-30","2021-10-07","2020-07-06","2021-11-02","2020-07-06","2022-09-30","2022-04-21","2021-01-27","2021-01-19","2021-03-08","2021-03-08","2021-04-23","2022-09-30","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2022-05-04","2022-09-30","2021-10-07","2021-04-13","2021-08-05","2021-07-14","2022-04-21","2022-09-30","2021-04-23","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-10-01","2022-09-27","2022-09-14","2021-04-14","2021-04-14","2022-01-20","2021-10-14","2022-09-30","2021-12-08","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2022-04-21","2022-01-10","2022-11-22","2021-11-02","2020-06-23","2021-08-05","2022-05-04","2022-01-10","2020-06-19","2020-06-19","2020-06-19","2022-04-19","2021-05-16","2022-09-13","2020-06-08","2022-09-30","2020-05-11","2022-01-10","2021-08-05","2020-06-03","2020-06-03","2020-06-03","2020-07-09","2020-07-09","2021-04-29","2021-04-29","2022-11-22","2020-06-10","2020-06-23","2020-08-26","2020-08-26","2020-08-26","2022-05-04","2020-10-07","2020-06-08","2022-05-16","2022-11-22","2020-06-08","2020-06-08","2020-06-08","2020-09-17","2021-12-08","2022-04-21","2021-08-05","2022-03-02","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2022-01-25","2022-04-19","2022-04-19","2022-01-25","2022-04-21","2022-01-25","2022-05-16","2022-05-16","2022-01-10","2022-01-10","2022-01-10","2022-01-10","2022-09-13","2022-04-19","2022-04-21","2022-09-30","2022-09-30","2022-09-30","2022-01-25","2022-10-11","2022-11-22","2022-11-22"],"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":[["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","VICTOZA","INJ 18MG\/3ML","","Select","Select",""],["","","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","LEVETIRACETA","TAB 500MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","90","Select","Select",""],["","","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","","LOSARTAN","TAB 25MG","","Select","Select",""],["","13107015490","PAROXETINE","TAB 10MG","30","Select","Select",""],["","","CLOBETASOL","CRE 0.0005","","Select","Select",""],["","","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","00002821517","HUMULIN","INJ U-100","15","Select","Select",""],["","","WARFARIN","TAB 5MG","","Select","Select",""],["","57896055501","SENNA-PLUS","TAB 8.6-50MG","30","Select","Select",""],["","","LAMOTRIGINE","TAB 25MG","","Select","Select",""],["","00536124701","SENEXON-S","TAB 8.6-50MG","30","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","57896045501","SENNA","TAB 8.6-50MG","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","METFORMIN","TAB 750MG ER","","Select","Select",""],["","","OXYBUTYNIN","TAB 10MG ER","","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","","ATROVENT","AER 17MCG","","Select","Select",""],["","","JARDIANCE","TAB 25MG","","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","","FREESTYLE    KIT SENSOR","KIT SENSOR","","Select","Select",""],["","","TRULICITY","INJ 1.5\/0.5","","Select","Select",""],["","86790001930","SLOW","TAB 45MG","90","Select","Select",""],["","59556025010","FERGON","TAB 27MG","90","Select","Select",""],["","","CVS","TAB 8.6-50MG","","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","ENOXAPARIN","INJ 80\/0.8ML","","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","1","Select","Select",""],["","","SOLIFENACIN","TAB 10MG","","Select","Select",""],["","","METOPROL","TAB 25MG","","Select","Select",""],["","","CONTOUR","KIT NEXT","","Select","Select",""],["","","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","","AMITRIPTYLIN","TAB 50MG","","Select","Select",""],["","","ACCU-CHEK","TES GUIDE","","Select","Select",""],["","","FASTCLIX","MIS LANCETS","","Select","Select",""],["","","BD  PEN NEEDL","MIS 32GX6MM","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}