{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NNAYHSNOTPMAH S","gend":1,"add":"3 4201TS HT4","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1974-06-21","age":"","mstatus":"","insh":"79500210*90","cliId":"","pno":"42\/7579431-5","cno":"757\/245-1349","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":["I10.","G47.33","I89.0","F41.1","F34.1","F90.2","E11.22","Z20.822","E11.40","B35.1","L84.","B35.3","M20.12","M20.11","E11.65","E11.42","Z01.818","R19.7","K92.1","E11.9","H25.13","H52.7","G89.29","M47.12","M54.12","E66.01","A04.8","D50.9","M54.2","J44.9","F17.210","Z72.0","M51.36","Z79.4","I27.82","I26.99","D50.8","I26.09","NO DATA","R00.1","D50.0","D64.9","Z71.9","E11.21","R41.0","R07.9","R06.02","L98.9","L60.3","I83.10","R94.31","N39.46","R35.1","G95.9","Z01.812","Z86.711","M48.02","M50.323","M50.322","L50.9","R21.","V58.89","T78.1XXA","M50.30","E08.622","L98.499","Z79.01","E66.3","M25.541","M25.542","F17.200","I82.90","E66.9","M67.431","M67.441","M65.321","M65.331","M65.341","Z01.811","B30.9","R05.","G47.9","J02.9","M19.90","M79.7","F31.9","K52.9","Z86.73","Z68.43","Z86.11"],"date":["2021-04-16","2021-12-08","2022-09-19","2022-04-19","2022-04-19","2022-04-19","2022-09-19","2022-03-02","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-12-06","2021-12-06","2022-01-07","2022-03-25","2022-03-25","2022-04-07","2022-04-07","2022-04-07","2020-04-16","2022-01-07","2022-01-07","2021-12-08","2020-07-28","2022-01-12","2020-05-26","2021-12-08","2021-09-21","2021-12-08","2021-09-08","2021-09-08","2020-05-18","2021-12-10","2021-09-08","2020-05-18","2021-09-08","2021-08-03","2021-12-10","2021-12-10","2021-12-10","2022-07-10","2022-07-10","2021-04-08","2020-06-09","2020-09-23","2021-01-08","2020-09-23","2021-04-08","2021-07-14","2021-07-14","2022-01-11","2021-08-03","2021-12-08","2022-01-11","2021-09-02","2021-05-24","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2021-09-08","2021-09-08","2021-09-08","2021-05-10","2020-07-28","2020-08-28","2020-08-28","2021-05-10","2021-05-10","2021-05-10","2021-09-02","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-06-08","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21"],"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":[["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","20","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","60","Select","Select",""],["","00363013820","SENNA","TAB 8.6MG","60","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","30","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","16","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","270","Select","Select",""],["","60505470203","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","18","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","45","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","27808023302","DOXYCYCL","CAP 100MG","7","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","55111032201","GLIMEPIRIDE","TAB 4MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00378932232","WIXELA","AER 500\/50","60","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","68462018117","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","69238147301","ERYTHROMYCIN","TAB 500MG EC","30","Select","Select",""],["","00254200501","CHLORZOXAZON","TAB 750MG","90","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","63824005736","MUCINEX","TAB 60-600MG","18","Select","Select",""],["","00085047405","AFRIN","SPR 0.0005","15","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","45","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","12","Select","Select",""],["","00713031788","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","120","Select","Select",""],["","43598029290","PREGABALIN","CAP 50MG","90","Select","Select",""],["","00169266015","TRESIBA","INJ 100UNIT","3","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","00591247501","TETRACYCLINE","CAP 500MG","56","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","56","Select","Select",""],["","43199001301","HYOSCYAMINE","TAB 0.125MG","60","Select","Select",""],["","59762026001","COLESTIPOL","GRA 5GM","60","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","14","Select","Select",""],["","67877012425","SILVER","CRE 0.01","25","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","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":""}]}]}