{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  HTENNEKZEPOL J ","gend":0,"add":"A TNIAS S 9121 TPA TS HPAS","city":"ALEXANDRIA","state":"VA","zip":"22314-9998","dob":"1968-11-08","age":"","mstatus":"","insh":"67600210*47","cliId":"","pno":"03\/3076381-4","cno":"703\/304-1836","email":"","ename":"","eno":"","pphy":"GUPTA, RAJESH MD","ppno":"703\/845-1500","pcpadd":"1500 N BEAUREGARD STREET SUITE 300","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":22311,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Norfolk General Hospital Tele-Stroke","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","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":["V58.89","V54.13","I10.","I82.409","I69.951","G40.509","I69.351","F41.1","S79.811A","Z74.3","I63.9","U07.1","G40.909","R41.82","I62.9","G81.91","R56.9","I69.310","I69.314","I69.311","I69.320","I69.90","G81.90","R94.01","R26.2","R26.81","M62.838","I69.398","M25.511","R27.9","M62.81","R47.01","R41.844","Z91.81","L25.9","I48.0","F10.10","J45.909","F41.9","S72.91XA","R00.0","W19.XXXA","Z98.890","Z79.01","I69.151","Z86.718","Z79.899","Z79.51","Z82.49","R27.8","R53.1","M62.89","Z76.89","R45.89","I61.9","R13.10","R60.0","G40.89","I69.114","I69.251","J69.0","I82.403","R33.9","J45.902","J30.2","S72.044A","R07.9","S72.141A","Z48.812","F43.22","M25.571","I82.402","K59.09","R52.","N40.1","R33.8","N20.0","Z87.01","L30.9","R50.9","I69.321","I61.0","Z00.8","S72.002A","N40.0","I82.4Z3","Z86.79","G81.11","I82.431","I82.412","T78.2XXA","Z86.73","Y92.009","NO DATA","Z20.822","Z88.5","R25.2","R10.2","S72.001A","T78.40XA","I69.393","I69.322"],"date":["2021-11-03","2021-11-03","2022-02-24","2021-11-03","2021-11-03","2021-11-03","2022-10-24","2022-09-22","2021-06-27","2021-06-27","2022-07-12","2022-01-25","2022-02-24","2022-01-25","2022-02-23","2022-03-04","2022-06-29","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-07-29","2022-02-24","2022-05-04","2022-05-04","2022-05-04","2022-07-29","2022-05-04","2022-05-04","2022-05-04","2022-07-29","2022-07-29","2022-05-04","2020-07-28","2021-07-07","2021-07-12","2022-02-21","2022-07-12","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-07-29","2022-07-29","2022-07-29","2022-07-12","2022-07-12","2020-07-28","2020-10-16","2020-08-14","2020-08-14","2020-08-14","2020-11-07","2020-10-16","2020-11-07","2020-10-16","2020-11-07","2020-11-07","2021-07-12","2021-06-30","2021-07-19","2020-08-01","2020-08-01","2020-07-08","2020-07-08","2020-08-06","2021-01-05","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-07-08","2020-07-20","2020-08-28","2021-02-10","2021-06-27","2021-06-30","2020-10-08","2021-07-12","2020-10-08","2021-01-05","2020-07-01","2020-07-01","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-07-01","2021-06-28","2021-06-28","2021-01-05","2021-01-05"],"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":[["","00131248035","VIMPAT","TAB 200MG","60","Select","Select",""],["","00603548232","PROPRANOLOL","TAB 10MG","30","Select","Select",""],["","16714035501","LEVETIRACETA","TAB 500MG","180","Select","Select",""],["","00078051205","TEGRETOL-XR","TAB 400MG","60","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","180","Select","Select",""],["","50474050015","NAYZILAM","SPR 5MG","8","Select","Select",""],["","69315090601","LORAZEPAM","TAB 2MG","20","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","30","Select","Select",""],["","59746038506","TERAZOSIN","CAP 5MG","90","Select","Select",""],["","29300014001","DIVALPROEX","TAB 500MG DR","180","Select","Select",""],["","51991035106","LACOSAMIDE","TAB 200MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","13107015430","PAROXETINE","TAB 10MG","30","Select","Select",""],["","50111032701","HYDRALAZINE","TAB 25MG","60","Select","Select",""],["","16714006501","CARBAMAZEPIN","TAB 400MG ER","60","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","30","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","90","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","180","Select","Select",""],["","72252050502","VALTOCO","SPR 5MG","4","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","2","Select","Select",""],["","47335001183","TADALAFIL","TAB 10MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","65162036110","FOLIC","TAB 1MG","90","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","180","Select","Select",""],["","43547035210","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","65862077990","OLM","TAB 20-12.5","60","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00185061501","HYDROXYZ","CAP 50MG","15","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00603020922","MAG","TAB 400MG","90","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00487950103","ALBUTEROL","NEB 0.00083","90","Select","Select",""],["","00955101010","ENOXAPARIN","INJ 100MG\/ML","10","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","36","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","00113048490","PAIN","TAB 500MG","24","Select","Select",""],["","57896086406","MELATONIN","TAB 3MG","3","Select","Select",""],["","10702000201","PROMETHAZINE","TAB 12.5MG","240","Select","Select",""],["","16714089803","LORATADINE","TAB 10MG","3","Select","Select",""],["","45717000851","THERACARE","PAD 0.04","10","Select","Select",""],["","00574705050","BISACODYL","SUP 10MG","3","Select","Select",""],["","00536124810","STIMULANT","TAB 8.6-50MG","3","Select","Select",""],["","00536121429","DIPHENHYDRAM","TAB 25MG","60","Select","Select",""],["","20555002700","TAB-A-VITE","TAB ","1","Select","Select",""],["","65162046450","IBUPROFEN","TAB 400MG","18","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":""}]}]}