{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   ACINOMNOSRETTAP ","gend":1,"add":"GOD 0223RD DOOW","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1980-03-13","age":"","mstatus":"","insh":"3933110*90","cliId":"","pno":"25\/7574210-8","cno":"757\/292-3951","email":"","ename":"","eno":"","pphy":"SCHIMMING, BARBARA G NP","ppno":"757\/983-2200","pcpadd":"3920 A BRIDGE RD STE 207","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - BelleHarbour","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":["E11.9","E11.649","E11.65","E11.40","I10.","R11.14","N32.81","F33.1","F90.0","Z01.810","N83.201","N83.202","I45.10","G47.33","K29.70","R11.2","K58.9","B96.81","G25.81","G47.00","G47.63","G43.909","F41.8","F90.9","R10.9","R20.0","Z71.9","R11.0","R19.7","A04.8","Z79.4","Z46.81","F41.9","E78.2","K21.9","E55.9","R06.00","I11.9","E78.5","R07.2","L03.211","E78.00","F98.8","E66.9","F90.2","F33.9","Z00.00","H10.45","R93.5","R30.0","E66.01","K92.0","G47.30","N76.4","R10.2","Z68.42","G43.809","H53.9","R53.1","L03.031","B95.61","Z01.811","R00.0","E11.42","L03.032","F41.1","G43.009","R10.31","K66.0","N73.6","K31.84","B35.1","B35.3","J06.9","L40.9","N83.209","R10.32","R10.30","R06.02","R73.9","Z87.891","R60.0","G43.709","N89.8","R53.83","B37.2","N39.0","R81.","R35.0","K42.9","Z80.41","M14.671","M14.672","E13.621","L97.521","R42.","Z76.89","E11.59","R51.9","E11.69","F31.62","Z12.31","L85.3","B37.3","G62.9","G43.119","S76.111A","S83.91XA","S86.911A","S93.601A","S93.401A","S96.911A","Z72.4","Z91.14","R80.9","R07.89","R05.","M47.816","R45.4","F31.61","Z23.","J20.9","Z96.41","K92.1","B37.9","H60.501","Z68.41","F32.9"],"date":["2021-08-19","2021-04-05","2021-12-17","2021-09-02","2021-09-02","2020-05-27","2020-05-27","2021-11-17","2021-11-17","2021-08-17","2020-06-06","2020-06-06","2020-06-03","2021-12-17","2021-05-10","2021-11-23","2021-11-23","2021-11-23","2020-01-28","2020-01-28","2020-01-28","2020-12-17","2020-06-06","2021-12-17","2021-05-17","2020-09-29","2021-04-14","2020-10-23","2021-04-21","2020-11-30","2021-12-17","2021-01-28","2021-01-28","2021-09-02","2021-01-28","2021-09-02","2021-05-27","2021-05-27","2021-05-27","2020-01-10","2020-01-13","2020-01-13","2020-04-09","2021-02-23","2020-06-03","2020-06-03","2020-08-24","2020-09-25","2020-11-23","2020-11-23","2021-09-02","2021-05-10","2021-05-18","2021-08-19","2021-05-17","2021-05-18","2021-01-21","2020-01-16","2020-01-16","2021-03-04","2021-10-04","2021-08-17","2021-08-17","2021-12-17","2021-10-04","2021-11-17","2020-06-02","2020-06-24","2020-06-24","2020-06-24","2021-03-05","2021-04-28","2021-04-28","2020-02-14","2021-03-02","2020-06-01","2020-06-01","2020-06-01","2021-04-14","2021-03-23","2021-03-23","2021-04-14","2021-12-17","2020-05-19","2020-05-19","2020-05-28","2020-05-28","2020-05-19","2020-05-28","2020-05-28","2020-06-02","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2021-01-21","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2020-08-09","2020-11-30","2021-03-05","2019-01-11","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-05-20","2019-05-20","2019-05-23","2019-05-23","2019-02-11","2019-04-11","2019-08-22","2019-09-17","2019-09-17","2019-01-28","2019-02-28","2019-10-16","2019-10-16","2019-11-07","2019-11-13","2019-03-07"],"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":[["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00002850101","HUMULIN","INJ U-500","20","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","6","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","7","Select","Select",""],["","68462050166","CALCIPOTRIEN","CRE 0.00005","120","Select","Select",""],["","00168004160","BETAMETH","LOT 0.001","60","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","68180031909","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","240","Select","Select",""],["","00378617301","METOLAZONE","TAB 5MG","5","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","28","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","90","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","30","Select","Select",""],["","08290326730","BD","MIS 31GX6MM","100","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","76300000260","GUARDIAN","MIS TRANSMIT","1","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","70710128403","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","6","Select","Select",""],["","00406114201","METHYLPHENID","TAB 5MG","30","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","25","Select","Select",""],["","31722088290","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","43547029010","BUPROPION","TAB 200MG SR","60","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","45","Select","Select",""],["","00168009960","KETOCONAZOLE","CRE 0.02","120","Select","Select",""],["","50458022130","NIZORAL","CRE 0.02","120","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00169413013","OZEMPIC","INJ 4MG\/3ML","3","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","20","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":""}]}]}