{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AHSRATSRETIAW N","gend":1,"add":"EREP 034TS ENIRG","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1973-04-12","age":"","mstatus":"","insh":"5414110*56","cliId":"","pno":"55\/7577488-9","cno":"","email":"","ename":"","eno":"","pphy":"MPOY KANYINDA, JEAN MARIE K MD","ppno":"757\/388-9925","pcpadd":"7401 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","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":["R05.","N30.00","J01.00","M13.0","E11.9","Z79.84","R42.","G47.33","E11.59","K21.9","E66.01","I10.","Z68.41","I83.813","D72.829","E78.5","M79.7","I15.2","I83.891","D72.825","F17.210","G89.29","Z78.9","R52.","B37.0","F33.1","I83.812","R07.9","R00.0","N20.0","R06.2","I25.10","Z82.49","Z83.3","Z79.899","Z88.0","Z88.8","Z88.2","H25.13","Z87.891","R94.5","K21.0","NO DATA","G57.83","G56.91","J30.89","R74.8","K76.0","Z12.11","D72.828","R06.83","Z23.","H81.13","N39.0","Z20.822","B37.3","N91.4","Z71.3","F17.200","K64.8","R39.89","R70.0","R79.82","G47.00","M72.2","L60.0","M79.671","R10.9","K29.00","R11.2","R10.84","M67.873","M25.532","M25.531","I83.819","J06.9","L03.031","L03.032","R50.9","Z87.898","T81.41XA","Z98.890","G47.9","N95.8","R23.2","M62.830","V58.89","E11.319","I83.811","H40.003","D72.820","E11.69","K59.00","Z12.31","S63.502A","R06.81","R40.0","R53.83","E55.9","Q61.5","E11.8","Z82.2","R11.0","M79.674","M79.675","E11.42","Z68.39","I87.2","R51.9","R09.81","R05.9","R07.89","M15.2","H90.3","Z01.812","Z51.81","Z79.891","B35.1","R06.02"],"date":["2020-01-22","2020-09-08","2020-09-08","2020-10-05","2022-08-27","2021-04-22","2021-04-29","2021-12-28","2022-04-29","2022-07-05","2022-08-27","2022-08-27","2022-07-05","2021-08-27","2022-01-26","2022-07-05","2022-07-05","2022-04-29","2021-09-13","2021-09-21","2022-08-27","2022-04-29","2021-12-14","2022-04-29","2022-01-26","2022-10-25","2022-03-22","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2020-02-28","2020-08-09","2020-08-10","2020-08-10","2022-10-13","2020-02-08","2020-02-08","2020-03-16","2020-09-21","2022-04-29","2020-09-24","2020-11-24","2021-04-21","2021-01-25","2022-04-29","2022-10-13","2022-01-18","2022-02-28","2022-04-05","2020-08-18","2022-02-23","2020-09-24","2020-11-30","2020-12-21","2020-12-21","2021-07-13","2021-12-14","2022-01-18","2021-12-14","2022-02-23","2022-03-02","2022-03-02","2022-03-02","2022-09-15","2020-09-30","2020-09-30","2021-07-26","2022-01-07","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2020-05-13","2020-05-13","2020-05-13","2020-06-22","2020-08-09","2022-03-08","2022-01-19","2022-03-08","2022-04-29","2022-07-05","2022-04-29","2022-04-29","2020-07-31","2021-03-22","2021-03-22","2021-04-22","2022-07-05","2021-06-28","2022-02-23","2022-02-23","2022-02-23","2021-03-02","2021-03-02","2021-08-17","2021-04-22","2021-08-27","2022-01-08","2022-01-08","2022-01-08","2022-01-08","2022-07-05","2021-03-02","2021-04-21","2021-08-10","2021-08-10","2021-08-17","2022-01-07"],"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":[]},{"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":[["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","180","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","43598044828","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00254302902","LUBIPROSTONE","CAP 24MCG","30","Select","Select",""],["","16729013700","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","30","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","50228035090","PREGABALIN","CAP 25MG","60","Select","Select",""],["","43598065530","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","29300024716","BUSPIRONE","TAB 30MG","30","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","65162063609","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","13668021630","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00574010770","CLOTRIMAZOLE","TRO 10MG","70","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","1","Select","Select",""],["","45802041926","AMMONIUM","LOT 0.12","400","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","15","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","51672130200","TERCONAZOLE","CRE 0.008","20","Select","Select",""],["","65862086099","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","30","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","60","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","58160089052","FLUARIX","INJ 2022-23","0","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","21","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00378037201","CIMETIDINE","TAB 400MG","90","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","29300011516","TOPIRAMATE","TAB 25MG","100","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","65","Select","Select",""],["","65162018810","NAPROXEN","TAB 250MG","15","Select","Select",""],["","59746021701","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","60","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","12","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","90","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":""}]}]}