{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C YTSIMYELWAR","gend":1,"add":"TELANAR 101531 TPA RD ","city":"HAMPTON","state":"VA","zip":"23664-9998","dob":"1970-05-10","age":"","mstatus":"","insh":"70000210*89","cliId":"","pno":"23\/7578438-9","cno":"","email":"","ename":"","eno":"","pphy":"JOYNER, AERIAN K NP","ppno":"757\/827-2025","pcpadd":"STE 300 4001 COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Senior Health Services","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":["B35.1","E11.40","M79.671","M79.672","Z01.419","N76.0","Z01.810","Z79.899","Z79.84","R93.89","Z01.818","R07.89","R51.","C50.411","Z17.0","E11.65","F41.9","I10.","F32.9","Z90.13","I47.1","I25.10","M54.31","R53.83","R06.02","E11.9","E55.9","E87.6","T78.1XXA","E66.9","E11.29","E11.69","E11.59","E66.01","R23.2","G43.111","F33.0","R80.9","E78.5","I15.2","Z86.010","K59.00","R14.0","Z08.","Z98.82","N64.4","L98.9","Z85.3","R00.0","S13.4XXA","S39.012A","S83.8X2A","B37.3","Z00.00","F33.41","Z23.","Z68.36","R35.0","N89.8","G43.909","Z02.9","Z01.89","R06.00","Z12.11","R25.2","N85.00","N92.1","E78.2","J01.00","J20.9","Z72.0","Z11.3","T78.2XXA","D12.2","R87.610","E88.81","Z48.816","J10.1","J04.0"],"date":["2019-03-29","2019-03-29","2019-03-29","2019-03-29","2020-10-15","2019-06-01","2019-06-20","2019-06-20","2019-06-20","2019-08-12","2019-06-20","2019-11-01","2019-11-01","2021-10-07","2021-10-07","2021-12-08","2019-10-10","2021-02-10","2019-10-10","2021-03-01","2021-09-30","2021-09-30","2020-01-16","2020-01-16","2020-08-31","2021-02-10","2020-09-22","2020-09-22","2021-03-24","2021-02-10","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-09","2021-12-09","2021-12-09","2019-01-31","2019-01-31","2019-02-12","2019-02-12","2019-01-31","2020-09-09","2020-11-16","2020-11-16","2020-11-16","2021-03-26","2019-06-21","2019-06-21","2019-06-21","2020-08-13","2021-03-12","2021-03-12","2020-07-20","2020-07-20","2020-07-13","2020-09-09","2021-11-18","2021-09-08","2019-06-27","2019-06-27","2019-11-04","2020-01-10","2019-02-21","2019-02-21","2020-10-15","2021-03-23","2021-11-18","2019-04-10","2019-04-10","2019-08-12","2020-01-10","2020-01-10"],"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":[["","68645030059","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","65862029590","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","14","Select","Select",""],["","51862044630","TAMOXIFEN","TAB 20MG","30","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","65862006399","METOPROL","TAB 50MG","60","Select","Select",""],["","","POT  CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","30","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","68180051701","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","53191036201","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","00254302802","LUBIPROSTONE","CAP 8MCG","30","Select","Select",""],["","53885099425","ONETOUCH","TES ULTRA BL","50","Select","Select",""],["","00527293537","PREDNISONE","TAB 50MG","3","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","","LOSARTAN\/HCT","TAB 100-25","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","CHLORTHALID","TAB 25MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","55111068405","IBU","TAB 800MG","90","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","13668013610","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","13668011530","LOSARTAN","TAB 100MG","30","Select","Select",""],["","00591024105","LORAZEPAM","TAB 1MG","1","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","55111029209","SUMATRIPTAN","TAB 50MG","10","Select","Select",""],["","69618002401","DIPHENHYDRAM","CAP 25MG","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":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}