{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIREHTACSEGDOH E","gend":1,"add":"C OREA 402901 TPA RI","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1963-12-02","age":"","mstatus":"","insh":"76600210*12","cliId":"","pno":"93\/7577922-4","cno":"757\/394-2297","email":"","ename":"","eno":"","pphy":"GEORGE, DYLAN M NP","ppno":"757\/726-5000","pcpadd":"200 EATON ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Old Hampton","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":["I47.2","I42.1","Z95.810","I10.","R55.","Z68.43","G43.711","I11.0","I50.33","J45.909","R07.9","R09.1","Z79.899","G35.","F43.10","E66.01","E87.6","F32.9","H91.90","F17.210","Z87.442","H25.013","H25.012","R05.","R68.83","R50.9","Z71.3","Q62.39","F41.9","F33.1","E66.9","N20.1","U07.1","R20.2","I42.2","G47.30","I49.5","Z95.0","Z88.6","Z88.3","Z91.041","Z91.013","R07.89","NO DATA","J96.01","N20.0","G40.909","R19.7","K21.9","Z68.42","Z90.711","Z87.440","J45.40","F50.9","M54.31","Z91.048","Z88.8","R10.9","N39.0","Z86.79","J06.9","Z20.822","R09.02","I42.9","I51.7","I34.8","M54.41","H26.8","H21.561","F41.1","N12.","I50.9","Z87.448","R93.429","I82.409","R51.9","Z87.01","D17.30","Z12.31","E55.9","S40.012A","S60.222A","R35.0","R10.2","R39.15","I25.10","R20.0","M25.552","M25.511","M25.551","V89.2XXD","Z01.818","H26.9","G89.29","Z23.","K59.00","L73.2","G43.909","R19.4","R11.2","Z12.11","F17.200","Z79.1","Z00.00","Z20.828","A41.51","N13.6","N17.9","Z87.891","R65.20","I50.31","L30.4","L72.9","J81.1","R11.0","Z09.","L85.3","Z71.9","G47.9","E46.","I42.0","M25.561","R10.13","H25.011","N30.00","R77.9","Z01.810","Z01.812","Z01.811","V58.69","R94.31","I12.9","N18.9","Z79.82","Z91.81","R10.11","Z96.0","R05.9"],"date":["2022-06-02","2022-07-08","2022-06-28","2022-07-11","2021-06-23","2022-07-11","2021-06-23","2022-06-28","2022-07-11","2020-10-21","2022-05-16","2020-10-18","2022-06-28","2022-06-28","2022-08-16","2022-06-28","2020-10-18","2020-10-18","2020-10-18","2022-06-28","2021-09-29","2020-11-24","2021-02-11","2021-04-12","2021-04-12","2021-10-02","2022-04-02","2021-05-13","2022-08-16","2022-08-16","2022-04-02","2021-09-27","2021-10-05","2021-10-02","2022-07-11","2022-06-28","2021-10-02","2021-10-02","2022-06-28","2022-06-28","2022-06-28","2022-06-28","2021-10-02","2021-10-05","2022-07-08","2021-10-05","2021-10-04","2021-10-04","2021-10-04","2022-05-16","2021-10-04","2021-10-04","2022-01-27","2022-02-12","2022-05-26","2022-05-26","2022-06-28","2022-05-26","2021-05-26","2020-10-21","2021-10-02","2021-10-02","2021-10-04","2021-10-06","2021-10-06","2021-10-06","2022-07-05","2021-01-14","2021-01-14","2021-03-04","2021-04-26","2022-06-28","2021-04-28","2021-06-10","2021-10-05","2021-12-30","2021-12-30","2022-03-18","2022-05-03","2022-05-03","2022-05-07","2022-05-07","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2021-06-25","2021-02-11","2021-05-26","2022-03-02","2021-10-29","2021-10-29","2021-10-29","2020-07-02","2020-08-12","2020-07-02","2020-10-19","2020-07-02","2020-11-18","2020-11-18","2021-04-25","2021-04-25","2021-04-25","2021-04-25","2021-04-25","2022-07-08","2022-03-16","2022-03-02","2022-05-16","2022-05-16","2022-07-08","2022-03-16","2022-03-16","2022-06-28","2020-10-18","2020-10-19","2020-11-02","2020-11-02","2021-01-14","2021-05-16","2021-06-09","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-27","2021-09-27","2021-09-27","2022-04-07","2021-04-24","2021-07-16","2021-10-02"],"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":[]},{"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":[["","59746021601","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","60","Select","Select",""],["","13107006101","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","51672126302","NYSTAT\/TRIAM","CRE ","60","Select","Select",""],["","00472016630","NYSTATIN","OIN 100000","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","45802041926","AMMONIUM","LOT 0.12","400","Select","Select",""],["","31604004070","D3","TAB 1000UNIT","30","Select","Select",""],["","78742043619","VITAMIN","TAB 500MG","30","Select","Select",""],["","00574916710","ZINCATE","CAP 220MG","30","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","72205001290","PREGABALIN","CAP 50MG","60","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","23155048601","VERAPAMIL","TAB 120MG","60","Select","Select",""],["","29300011616","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","16714065204","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","16714012303","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","28","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","30","Select","Select",""],["","49035007860","EQ","CAP SOFTENER","60","Select","Select",""],["","00121174400","GUAIFENESIN","SOL 100\/5ML","100","Select","Select",""],["","69367027204","CODEINE\/GG","SOL 10-100\/5","120","Select","Select",""],["","00904533260","ZINC","CAP 50MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","51267089099","CONTRAVE","TAB 8-90MG","60","Select","Select",""],["","65862014836","SUMATRIPTAN","TAB 100MG","12","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":""}]}]}