{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" M   AILUJYELDNAH 'O","gend":1,"add":"UG 9022TC YELR","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1996-06-26","age":"","mstatus":"","insh":"7738110*09","cliId":"","pno":"77\/7577661-8","cno":"757\/268-9249","email":"","ename":"","eno":"","pphy":"JACKSON, PAMELA E MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","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":["R39.15","R35.1","N39.41","R39.89","I10.","L70.0","L01.01","H02.814","H16.143","H11.433","H60.92","H66.93","Z32.02","R03.0","I49.9","I50.9","M54.2","M54.9","Z11.1","L30.9","N30.10","Z01.419","R10.2","R39.16","R39.14","R35.0","N30.11","Z20.828","R30.0","F41.9","Z79.899","F17.210","M25.549","S69.80XA","V58.89","M25.531","N32.81","R10.33","N32.9","I44.0","Z86.79","D48.5","J06.9","B96.89","H66.92","Z20.822","K52.9","R25.2","R11.0","R06.00","R00.2","R06.01","O90.3","R42.","E66.09","I44.1","I49.1","I49.3","Z11.59","F33.1","K59.00","R14.0","Z76.89","O02.81","O99.411","Z82.49","O99.331","Z3A.01","O20.9","O03.9","O20.0","N70.11","M54.5","R53.83","Z68.35","E66.9","N30.00","Z01.818","R00.1","N94.10","Z53.21","A08.4","Z32.01","O34.81","N83.12","V23.87","O99.341","N92.0","Z01.411","K21.0","J30.2","H01.116","S00.83XA","T07.XXXA","S06.0X1A","H93.12","H92.02","Z87.891","S09.90XA","N76.3","R40.20","V89.2XXA","H10.33","B30.9","NO DATA","N89.8","R87.612","Z01.812","G47.9","B34.9","R19.7","R40.0","N30.01","B37.3","O21.9","O99.280","E55.9","O99.419","O16.9","I11.0","Z3A.00","Z87.59","O99.891","O21.0","Z3A.14","R11.10","R50.9","O10.911","O26.899","R51.9","Z3A.12","Z00.00","F33.2","Z68.39","O23.41","R11.2","N76.0","O16.1","O26.892","O99.332","Z53.29","B35.4","K59.01","R10.84","O99.612","O99.012","O99.112","D72.829","D64.9","Z87.440","Z88.8","Z3A.19","Z68.37","O98.812","Z3A.17","L29.9","R10.9","K43.9","Z3A.23","N91.2","Z33.1","R30.9","Z3A.22","O99.513","J01.90","Z39.1"],"date":["2021-10-23","2020-09-24","2020-09-24","2020-09-24","2022-02-16","2021-07-29","2021-07-29","2021-11-01","2021-11-01","2021-11-01","2021-11-24","2021-11-24","2022-04-20","2022-03-20","2020-08-25","2022-09-04","2021-04-09","2021-03-07","2021-05-05","2021-05-10","2022-05-25","2020-08-20","2021-12-20","2020-09-16","2020-09-16","2020-09-16","2022-02-16","2021-10-07","2022-09-02","2022-04-08","2022-09-04","2022-09-25","2020-02-18","2020-03-06","2020-03-06","2020-03-06","2020-05-07","2020-05-07","2020-08-25","2020-06-26","2022-09-25","2020-11-04","2021-11-16","2021-11-16","2021-11-16","2022-10-25","2021-12-02","2021-12-20","2022-07-11","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2022-02-14","2020-12-08","2020-12-08","2020-12-08","2021-04-08","2021-11-02","2021-05-13","2021-05-13","2021-04-08","2021-12-15","2022-07-27","2022-09-04","2022-07-27","2022-06-13","2021-12-15","2021-12-22","2021-12-22","2022-03-23","2021-03-09","2022-04-26","2021-06-03","2022-04-26","2022-04-20","2020-05-18","2020-05-18","2020-09-11","2020-11-27","2021-10-07","2022-05-16","2021-12-13","2021-12-13","2022-06-13","2021-12-13","2022-02-21","2020-07-09","2019-03-10","2019-04-17","2019-05-26","2019-06-30","2019-06-30","2019-09-27","2019-09-27","2019-09-27","2019-11-23","2019-09-27","2019-05-24","2019-09-26","2019-09-26","2019-11-23","2019-11-23","2019-11-23","2019-07-23","2022-09-27","2019-09-03","2019-02-19","2019-05-16","2019-12-26","2019-02-05","2022-10-15","2022-06-01","2022-07-27","2022-06-26","2022-06-26","2022-06-26","2022-06-26","2022-06-26","2022-10-25","2022-06-26","2022-06-26","2022-07-27","2022-07-27","2022-07-27","2022-04-08","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-02-01","2022-02-16","2022-02-14","2022-06-05","2022-07-26","2022-05-23","2022-07-11","2022-09-25","2022-09-25","2022-07-26","2022-08-17","2022-09-04","2022-09-04","2022-09-25","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2022-09-25","2022-09-04","2022-04-26","2022-08-17","2022-08-17","2022-08-17","2022-09-25","2022-09-25","2022-09-25","2022-05-16","2022-05-16","2022-06-01","2022-09-27","2022-10-25","2022-10-25","2022-11-10"],"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":{"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":[["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","42192080201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","00591333119","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","","HYDROXYZ","CAP 50MG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","00169430313","RYBELSUS","TAB 3MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","51672138601","FLUOCINONIDE","CRE 0.0005","45","Select","Select",""],["","68180086573","BLISOVI","TAB 43831","84","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","62332003731","LAMOTRIGINE","TAB 25MG","46","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","10","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00378461501","DOXYL\/PYRID","TAB 10-10MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","00115164501","NITROFUR","CAP 100MG","14","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","10135014901","DIPHENHYDRAM","CAP 25MG","10","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","24","Select","Select",""],["","68682010810","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","00536100836","ASPIRIN","CHW 81MG","60","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","60","Select","Select",""],["","51672200102","MICONAZOLE","CRE 0.02","30","Select","Select",""],["","68462018117","CLOTRIMAZOLE","CRE 0.01","15","Select","Select",""],["","51672136208","NAFTIFINE","CRE HCL 1%","90","Select","Select",""],["","00168034646","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","364","Select","Select",""],["","00781214501","AMPICILLIN","CAP 500MG","28","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00363021807","ASPIRIN-81","CHW 81MG","60","Select","Select",""],["","","VENLAFAXINE","CAP 37.5 ER","","Select","Select",""],["","","ENTRESTO","TAB 24-26MG","","Select","Select",""],["","60432046400","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","45749001781","VSL#3","CAP 112.5BIL","30","Select","Select",""],["","","ETODOLAC","TAB 400MG","","Select","Select",""],["","59651031477","TIZANIDINE","CAP 2MG","30","Select","Select",""],["","00378808345","TRETINOIN","CRE 0.0005","45","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","16","Select","Select",""],["","45802073684","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","OXYBUTYNIN","TAB 5MG ER","","Select","Select",""],["","","MYRBETRIQ","TAB 25MG","","Select","Select",""],["","00472015515","NYSTAT\/TRIAM","OIN ","30","Select","Select",""],["","60846050201","PYRIDIUM","TAB 200MG","9","Select","Select",""],["","","URIBEL","CAP 118MG","","Select","Select",""],["","","ELMIRON","CAP 100MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","TROSPIUM","CAP 60MG ER","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","AMITRIPTYLIN","TAB 25MG","","Select","Select",""],["","65162003311","APAP\/CODEINE","TAB 300-30MG","21","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00501200024","BENADRYL","CAP 25MG","24","Select","Select",""],["","64125012710","FOLIC","TAB 1MG","30","Select","Select",""],["","62559049001","DIPHEN\/ATROP","TAB 2.5MG","30","Select","Select",""],["","00065401105","ZADITOR","DRO 0.025%OP","5","Select","Select",""],["","71186000235","VILAMIT","CAP 118MG","16","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":""}]}]}