{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLICSIRPSELOC A","gend":1,"add":"B ELTTIL 509B TPA EVA YA","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1976-12-16","age":"","mstatus":"","insh":"4446110*63","cliId":"","pno":"85\/7574446-9","cno":"","email":"","ename":"","eno":"","pphy":"GATA JR, RENATO G MD","ppno":"757\/395-1900","pcpadd":"5460 WESLEYAN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Wesleyan","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":["Z20.828","Z11.59","L70.0","L81.0","G47.00","F43.23","G43.009","G40.901","R41.89","R45.1","E87.2","V58.89","J96.01","R51.9","F11.20","F14.20","F13.20","F17.210","F41.1","L84.","T50.901A","T23.191A","Z72.0","G44.319","Z09.","R40.20","R56.9","NO DATA","E87.6","Z79.899","M79.676","Z00.00","Z13.29","Z12.31","H53.8","R35.0","Z13.228","Z13.0","N89.8","N92.0","Z20.2","F17.200","Z01.419","T40.2X1A","T23.131A","M54.9","I49.9","F51.04","G43.809","T50.904A","N76.0","R00.0","T40.601A","J01.90","B37.0","A08.4","T20.20XA","Z20.822","R50.9","R11.0","T50.Z95A","M20.41","M20.42","L11.0","M79.674","R41.82","T43.291A","A41.9","N39.0","T40.411A","F41.9","R73.9","F43.20","F11.23","F14.21","G43.909","S46.911A","Z23."],"date":["2021-02-11","2021-02-11","2021-10-06","2021-10-06","2022-10-14","2022-10-14","2022-10-14","2022-04-12","2022-04-13","2022-04-11","2022-04-11","2022-04-12","2022-04-12","2022-05-31","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2020-11-23","2022-03-13","2022-03-13","2022-03-13","2022-03-24","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-04-10","2020-07-26","2021-09-07","2021-09-07","2022-10-19","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2022-10-19","2021-09-23","2021-09-23","2021-09-23","2022-10-19","2022-05-25","2022-03-13","2022-03-13","2022-04-10","2022-04-13","2022-04-13","2022-05-24","2022-05-26","2022-09-19","2022-09-19","2020-01-16","2020-01-16","2020-01-16","2022-03-15","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2022-03-13","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-05-26","2022-05-25","2022-05-25","2021-10-15","2022-11-23"],"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":[["","16729013616","CLONAZEPAM","TAB 0.5MG","6","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","68180078001","ZOLPIDEM","TAB 12.5MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","120","Select","Select",""],["","29300014901","QUETIAPINE","TAB 100MG","90","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","42195095510","BUT\/APAP\/CAF","CAP ","20","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","21","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","67877012450","SILVER","CRE 0.01","50","Select","Select",""],["","59779073041","CVS","CRE 7","45","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","7","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","6","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","90","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","56","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","21","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","51672401801","ETODOLAC","TAB 400MG","20","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","33342030111","ESZOPICLONE","TAB 3MG","30","Select","Select",""],["","50383008704","GUAIATUSS","SYP 100-10\/5","118","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","10","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","200","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":""}]}]}