{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LYREHCSENRAB D","gend":1,"add":"IVHSRAM 401L TPA RD WE","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1964-08-26","age":"","mstatus":"","insh":"63200210*90","cliId":"","pno":"32\/7577500-4","cno":"757\/358-1918","email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":"757\/594-1850","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","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":["R07.89","E78.00","R14.0","R19.12","K59.00","K51.90","L29.9","J35.8","E66.3","V58.89","Z91.018","R07.81","R79.89","R91.8","S92.424A","J02.9","M76.62","S96.911A","M21.612","M21.611","M20.11","M20.12","M79.671","R26.2","R15.2","R19.8","R19.7","K21.9","H65.01","M62.838","K11.20","M54.2","H92.01","J30.89","H69.81","R07.0","J35.1","J35.01","H10.13","E87.6","K51.819","R20.0","R20.2","R13.10","H93.8X3","H69.83","Z20.822","M79.674","R00.2","R91.1","M25.561","M25.511","M25.562","G89.29","M25.512","R19.4","R07.9","E78.2","M79.7","M77.51","M77.52","S33.5XXA","R52.","M79.622","R94.5","L50.9","R23.8","K31.89","K44.9","S39.012A","M47.816","H92.03","R09.81","J34.3","Z00.00","Z13.220","K51.919","L30.9","L81.9","Z71.9","K22.8","R10.13","R19.5","M47.812","F51.01","R42.","Z23.","E55.9","H43.393","Z12.4","R21.","H25.813","H40.023","K52.9","H40.9","Z79.899","Z88.1","Z88.0","R20.8","NO DATA","J02.0","M79.672","H40.1132","S90.852A","R05.","M54.6","Z79.1","K52.89","R93.3","R09.82","J30.5","J34.2","I49.1","I49.3","H04.121","H04.122","H10.45","J32.0","G25.81","U07.1","I08.1","B34.9","E78.5","Z79.82","R05.9","S90.31XA","H43.813","H25.13","H53.002","H52.4","L29.8","R63.5","D18.01","Z01.419","M79.89","I34.0","I78.1","L43.9","D23.9"],"date":["2020-10-13","2022-04-04","2021-03-22","2021-03-22","2022-10-21","2022-10-21","2022-03-21","2022-10-13","2021-07-26","2021-07-26","2021-04-26","2022-02-22","2021-12-22","2021-12-22","2020-02-26","2020-08-12","2020-03-03","2020-03-11","2020-06-24","2020-03-03","2022-08-15","2022-08-15","2022-07-15","2020-03-11","2020-07-07","2020-07-07","2020-07-07","2022-10-21","2020-08-30","2020-08-30","2021-03-26","2021-11-30","2020-11-16","2022-10-13","2020-11-16","2021-04-12","2021-07-26","2021-07-26","2021-07-26","2021-01-06","2021-01-06","2022-07-06","2022-10-04","2021-02-24","2021-03-26","2021-03-26","2022-04-04","2020-02-26","2022-06-06","2021-11-30","2021-12-21","2022-08-09","2022-03-21","2022-03-21","2021-11-30","2020-01-30","2022-09-01","2022-07-06","2022-04-04","2022-08-15","2022-08-15","2022-05-23","2020-08-12","2020-08-12","2021-12-01","2020-12-23","2020-12-29","2021-02-11","2021-02-11","2022-05-23","2021-09-17","2022-01-27","2022-10-13","2022-10-13","2022-07-06","2021-06-17","2022-03-21","2021-01-11","2021-01-11","2022-09-15","2021-02-08","2021-02-08","2021-06-17","2021-12-21","2021-12-21","2019-06-05","2019-06-05","2019-06-05","2019-06-18","2019-06-05","2022-03-21","2019-06-18","2019-06-18","2019-11-25","2019-11-25","2022-04-04","2019-11-25","2019-11-25","2019-02-14","2019-02-14","2019-02-14","2019-04-29","2019-09-04","2019-07-31","2019-10-24","2019-02-10","2019-02-10","2019-11-27","2019-11-27","2022-01-27","2022-01-27","2022-10-13","2022-03-03","2022-03-03","2022-08-10","2022-08-10","2022-08-10","2022-05-26","2022-10-04","2022-01-05","2022-02-21","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-05-23","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-02-17","2022-05-04","2022-07-06","2022-07-06","2022-08-09","2022-02-22","2022-09-15","2022-09-15","2022-09-15"],"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":[["","59651036205","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","","SIMVASTATIN"," SIMVASTATIN ","30","Select","Select",""],["","00023916360","RESTASIS","EMU 0.05% OP","60","Select","Select",""],["","","CALCIUM"," CALCIUM ","60","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","60505620201","CYCLOSPORINE","EMU 0.0005","180","Select","Select",""],["","70700014617","FLUOCINONIDE","OIN 0.0005","60","Select","Select",""],["","","LANSOPRAZOLE","CAP 30MG DR","","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","60","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","60","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","70","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","00078091112","XIIDRA","DRO 0.05","60","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","28","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","45963055550","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","11523726803","MIRALAX","POW 3350 NF","90","Select","Select",""],["","00168003346","BETAMETH","OIN 0.001","45","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","68682011320","MESALAMINE","CAP 0.375GM","120","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","14","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","37000014343","ALIGN","CAP 4MG","30","Select","Select",""],["","00121085416","SULFATRIM","SUS 200-40\/5","280","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","62559049001","DIPHEN\/ATROP","TAB 2.5MG","45","Select","Select",""],["","70069009101","AZELASTINE","DRO 0.0005","6","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","42937070210","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","63824005718","MUCINEX","TAB 60-600MG","18","Select","Select",""],["","70069000701","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00781713593","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","BUDESONIDE","CAP 3MG","","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","53489012002","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","","PAIN","TAB 500MG\/RR","","Select","Select",""],["","","CLARITIN-D","TAB 5-120MG","","Select","Select",""],["","","CEFPODOXIME","TAB 200MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","VANCOMYCIN","CAP 125MG","","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":""}]}]}