{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ADNAWALEROMEZAB A","gend":1,"add":"NEEUQ W 106403 TPA TS ","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1976-08-29","age":"","mstatus":"","insh":"63200210*49","cliId":"","pno":"66\/7570706-0","cno":"757\/232-1264","email":"","ename":"","eno":"","pphy":"HUNTER, ROBERT H MD","ppno":"757\/827-2025","pcpadd":"STE 300 4001 COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["E11.65","Z79.4","G43.009","G93.2","Q07.00","G47.33","R41.3","I10.","F34.1","R32.","R39.81","E11.49","M20.41","M20.42","V58.89","Z12.31","E78.2","J45.40","E66.01","F60.3","S43.001A","V62.85","R42.","L02.214","F99.","F41.9","E11.40","J45.909","K21.9","L25.9","Z68.42","Z88.6","Z91.040","G47.30","Z91.51","F17.210","Z79.51","Z79.899","M75.51","R21.","F31.81","E28.2","Z68.43","Z99.89","Z88.8","M25.511","M75.52","M25.512","E11.9","E11.69","E11.59","E78.5","H40.023","Z11.59","L30.9","D64.9","J30.1","L21.9","M79.602","NO DATA","D72.829","R07.9","G89.29","I15.2","L60.3","L84.","R60.1","M79.672","M79.671","R35.0","S80.02XA","M25.531","M25.532","R10.84","B37.9","Z23.","L24.89","E55.9","H25.13","R27.0","J22.","J45.41","M17.11","L21.8","L81.0","H16.223","R11.2","S40.012A","H35.361","L25.8","F32.89","R51.9","S90.31XA","R19.7","N92.1","Z12.4","G56.01","M77.8","J45.21","R05.","M65.9","R73.09","L73.9","V78.6XXA","Y92.410","M77.9","M72.2","M25.571","R10.9","R31.0","J45.20","M12.812","G56.03","I80.9","F33.1","M25.431","M25.432","Z81.1","Z82.61","Z82.3","Z82.0","Z82.2","M79.89","E11.42","B35.1","S46.011A","Z02.2","G43.109","R52.","M75.41","M19.011","E78.00","M25.519","R03.0","G43.809","F31.0","M20.40","V62.84","Z03.818"],"date":["2022-11-15","2022-11-15","2021-08-30","2022-05-17","2022-05-17","2022-11-15","2022-05-17","2022-10-15","2022-08-12","2022-06-03","2022-06-03","2020-07-22","2020-07-22","2020-07-22","2021-08-31","2022-09-27","2022-06-22","2022-11-15","2022-11-15","2020-12-07","2021-07-17","2021-07-17","2021-08-31","2021-11-15","2021-11-15","2021-11-15","2022-09-16","2022-09-16","2022-10-15","2021-11-15","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-06-22","2022-09-16","2022-09-16","2022-09-16","2021-12-01","2020-01-05","2020-01-05","2021-04-30","2022-11-15","2020-01-05","2020-01-05","2022-09-16","2020-06-17","2020-06-17","2022-10-15","2022-11-15","2022-11-15","2022-11-15","2021-06-07","2021-06-10","2021-06-10","2021-06-10","2022-03-29","2021-06-10","2022-09-27","2022-06-22","2021-06-24","2021-06-10","2020-04-29","2022-11-15","2020-06-11","2022-08-19","2020-06-11","2022-03-29","2022-03-29","2020-01-23","2020-06-28","2020-07-25","2020-07-25","2021-04-30","2020-08-17","2022-09-27","2020-10-23","2022-03-29","2021-05-10","2021-08-30","2020-02-21","2020-02-21","2020-02-21","2020-08-31","2020-08-31","2020-11-03","2021-04-30","2019-03-06","2019-05-07","2019-08-09","2019-12-12","2022-05-17","2019-05-10","2019-08-17","2019-09-12","2019-09-12","2019-01-10","2019-01-10","2019-02-16","2019-02-16","2019-03-20","2019-02-19","2019-08-21","2019-03-06","2019-03-06","2019-03-20","2019-05-10","2019-05-10","2021-06-10","2021-06-10","2021-06-10","2019-04-18","2019-04-18","2019-08-17","2022-03-11","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-08-19","2022-08-19","2022-09-27","2022-10-15","2022-10-15","2022-03-04","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-10-02","2022-03-29","2022-03-29","2022-05-13","2022-10-02","2022-10-02"],"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":[["","65862059505","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","","CICLOPIROX","SHA 0.01","","Select","Select",""],["","","POT  CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","","FEROSUL"," FEROSUL ","30","Select","Select",""],["","","TOPIRAMATE"," TOPIRAMATE ","90","Select","Select",""],["","","DULOXETINE"," DULOXETINE ","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","100","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","11917004813","INSULIN","MIS 1ML\/31G","10","Select","Select",""],["","","METFORMIN"," METFORMIN ","120","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","59651032430","FLUOXETINE","TAB 60MG","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","BD  PEN NEEDL"," BD  PEN NEEDL","100","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","LOVASTATIN"," LOVASTATIN ","30","Select","Select",""],["","","LANTUS"," LANTUS ","3","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","","SUMATRIPTAN"," SUMATRIPTAN ","9","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","10","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","68462053253","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","30","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","METHOCARBAM"," METHOCARBAM ","60","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","8","Select","Select",""],["","00713072737","MOMETASONE","OIN 0.001","45","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","90","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","","DESONIDE","CRE 0.0005","","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","","MICONAZOLE","CRE 0.02","","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","30","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","","DIPHENHYDRAM","CAP 25MG","","Select","Select",""],["","","COMPL  NEEDLE MI","MIS COLL SYS","","Select","Select",""],["","","BENADRYL","CRE 1-0.1%","","Select","Select",""],["","","BANOPHEN","CAP 25MG","","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","180","Select","Select",""],["","","ACETAMINOPHE","TAB 325MG","","Select","Select",""],["","","MAPAP","TAB 325MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","BP","MIS AUTO ARM","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","ANTI-ITCH","CRE 1-01%","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}