{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B M   DAHCNOTSIKCAL","gend":0,"add":"EDAM 3105DAOR ARI","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1974-01-03","age":"","mstatus":"","insh":"4110210*47","cliId":"","pno":"07\/7571870-1","cno":"757\/701-0781","email":"","ename":"","eno":"","pphy":"BORRERO, CHARIN M PA","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","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":["M54.5","Z09.","I10.","E78.5","R56.9","F90.2","A09.","R19.7","L57.0","L40.9","D36.10","G47.33","J32.1","J06.9","F33.1","F51.9","G47.8","G47.31","M54.41","E66.01","L40.0","Z13.220","M54.42","G89.29","M12.9","M79.2","NO DATA","M62.838","R13.10","M53.3","M16.0","M70.61","M47.816","M51.37","M47.817","J20.9","R06.2","R05.2","J45.21","D89.9","R41.840","F33.42","D18.01","Z79.899","D23.5","Z11.3","Z79.2","Z86.14","Z88.5","Z87.891","Z86.11","J30.1","M51.36","J45.909","Z88.6","L73.9","R29.898","Z88.8","R13.12","K12.1","K29.00","K76.0","R11.2","R00.0","L23.7"],"date":["2020-11-25","2021-04-09","2022-04-27","2022-04-27","2021-04-09","2022-10-19","2021-07-19","2021-07-22","2022-05-10","2022-10-13","2021-07-29","2022-10-13","2022-05-03","2022-08-29","2020-04-13","2020-06-09","2020-06-09","2020-06-09","2022-08-08","2022-08-08","2020-12-03","2020-12-03","2021-10-19","2022-10-13","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2020-03-06","2022-09-23","2021-09-17","2022-09-23","2022-10-13","2022-09-23","2022-09-23","2022-09-07","2022-09-07","2022-09-07","2020-08-03","2020-09-18","2020-08-03","2022-10-13","2020-10-07","2022-10-13","2020-10-07","2021-10-19","2021-12-09","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-04-27","2022-10-13","2022-10-13","2022-10-13","2021-01-12","2021-02-02","2021-10-26","2020-02-17","2020-02-17","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2021-03-29"],"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":[["","43547035410","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","00002144511","TALTZ","INJ 80MG\/ML","4","Select","Select",""],["","42806001101","SULINDAC","TAB 200MG","60","Select","Select",""],["","00406114601","METHYLPHENID","TAB 20MG","90","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","59746021106","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","11822505390","RA","TAB 10MG","30","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","60505265501","TRAZODONE","TAB 150MG","90","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","29300034301","BACLOFEN","TAB 10MG","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","40","Select","Select",""],["","57894064011","TREMFYA","INJ 100MG\/ML","1","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","30","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB ","6","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","62332001131","VENLAFAXINE","TAB 75MG","90","Select","Select",""],["","65162063609","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","69238153205","CLOBETASOL","CRE 0.0005","30","Select","Select",""],["","51862006301","DIAZEPAM","TAB 5MG","12","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","18","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}