{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LYREHCSNIGDUH A","gend":1,"add":"OWLE 111DAOR DO","city":"NEW POINT","state":"VA","zip":"23125-9998","dob":"1967-05-04","age":"","mstatus":"","insh":"59200210*00","cliId":"","pno":"58\/4083804-4","cno":"","email":"","ename":"","eno":"","pphy":"BURRIS, SHANNON D NP","ppno":"804\/210-1025","pcpadd":"SUITE 210 5659 PARKWAY DR","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":23061,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Gloucester","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["J44.1","B37.0","R05.","K59.00","F41.9","R10.9","R60.0","R11.2","R10.31","Z98.890","T63.481S","M25.562","J30.1","Z87.19","G89.29","H93.293","H61.22","R13.13","R49.0","K21.9","E66.9","Z72.0","J01.81","J30.89","L02.511","J44.9","F17.200","R53.83","R52.","R51.9","R11.0","S10.96XA","R45.86","R41.840","W57.XXXA","D48.5","L91.8","L57.8","L73.8","S61.209A","Z86.14","S61.200A","Z48.01","S60.221A","Z12.11","Z12.31","Z96.641","M25.551","J38.1","R06.2","D69.2","L72.3","L90.5","L72.0","H61.23","F90.9","J06.9","F90.2","F41.0","F33.0","H92.02","R07.9","H69.83","J40.","R06.02","G90.519","R19.5","Z79.52","L60.8","Q74.2","H92.03","N61.1"],"date":["2021-04-05","2021-04-05","2020-02-12","2020-01-20","2021-10-14","2020-03-24","2021-12-27","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-04-05","2020-08-18","2020-08-18","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-11-03","2021-11-03","2021-12-27","2021-12-27","2021-12-27","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2021-12-26","2021-12-26","2021-12-26","2021-12-27","2021-04-05","2021-04-05","2021-04-05","2020-02-10","2020-02-10","2020-02-12","2020-02-12","2020-08-13","2020-08-13","2020-08-12","2020-08-13","2020-12-09","2021-10-14","2019-03-02","2019-03-05","2019-03-05","2019-03-05","2019-09-16","2019-08-13","2019-10-21","2019-10-02","2019-12-12","2019-12-12","2019-07-08","2019-07-08","2019-11-09","2019-11-09","2019-10-21","2019-05-08"],"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":[["","00591079401","DICYCLOMINE","CAP 10MG","60","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","10702000601","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","150","Select","Select",""],["","67253090150","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","59762014501","PIROXICAM","CAP 20MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","10","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","","CODEINE\/GG","SOL 10-100\/5","","Select","Select",""],["","16714040102","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","51672400301","NORTRIPTYLIN","CAP 50MG","60","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","40","Select","Select",""],["","00487950125","ALBUTEROL","NEB 0.00083","150","Select","Select",""],["","00591379830","IPRATROPIUM","SOL 0.02%INH","150","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","53746027205","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","35","Select","Select",""],["","00781196260","CLARITHROMYC","TAB 500MG","20","Select","Select",""],["","27808008602","HYD","SUS 10-8\/5ML","100","Select","Select",""],["","","PEG3350","POW ","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","","MOXIFLOXACIN","TAB 400MG","","Select","Select",""],["","31722055190","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","","PROMETHEGAN","SUP 25MG","","Select","Select",""],["","","CELECOXIB","CAP 200MG","","Select","Select",""],["","","FEXOFENADINE","TAB 180MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","","LEVOFLOXACIN","TAB 750MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","68462056417","MUPIROCIN","CRE 0.02","15","Select","Select",""],["","00004080085","TAMIFLU","CAP 75MG","10","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","57963010316","G","LIQ 100-10\/5","120","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","47781019605","OXYCOD\/APAP","TAB 5-325MG","14","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","65862019299","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","30","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":""}]}]}