{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   EIRREKNAYIUHB L","gend":1,"add":"OTIDRA 0111901 TPA TC ","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1969-12-03","age":"","mstatus":"","insh":"83200210*19","cliId":"","pno":"54\/7571000-2","cno":"","email":"","ename":"","eno":"","pphy":"JAVIER, ROSA M MD","ppno":"757\/395-1900","pcpadd":"5460 WESLEYAN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Wesleyan","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.2","F31.5","F43.10","F90.2","F50.01","M25.571","R59.0","N30.01","K08.89","F31.4","J01.00","K12.0","S90.112A","R11.0","H60.91","L30.9","G56.03","H81.13","L03.818","E87.6","F33.1","F51.01","F41.1","F90.0","I10.","Z11.3","Z11.4","F60.3","R56.9","N76.2","R22.1","F44.5","H93.293","Z72.0","H61.23","H93.299","R51.","R42.","R51.9","R90.82","F33.2","R41.840","F41.9","N30.00","F32.9","Z76.0","F31.81","F31.32","F31.64","F43.12","F17.200","F14.99","K22.8","F31.2","F14.90","F31.9","F43.23","B18.2","K21.9","R19.7","Z12.11","F19.10","R44.3","Z91.14","L03.032","G89.29","M54.5","F17.210","Z90.710","Z88.2","Z88.5","Z88.6","Z88.8","Z91.040","R68.89","F31.89","V58.89","S00.01XA","F41.3","R45.1","V62.84","V62.85","F51.5","M54.2","Z04.3","W19.XXXA","Y92.009","F14.20","Z23.","F32.1","K21.0","Z51.81"],"date":["2021-07-23","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-04-06","2020-03-19","2020-03-19","2020-03-19","2020-07-20","2020-09-08","2020-09-08","2021-07-25","2021-07-25","2020-08-28","2020-08-24","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2022-09-21","2022-09-21","2022-09-21","2022-09-21","2022-08-11","2020-08-28","2020-08-28","2021-09-12","2020-04-06","2020-04-06","2020-04-06","2020-08-14","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-08-11","2021-03-25","2021-03-25","2021-03-25","2021-12-21","2019-01-16","2019-05-22","2019-04-01","2019-02-18","2019-02-18","2019-09-26","2019-04-21","2019-05-10","2019-05-10","2019-05-10","2019-05-10","2019-05-03","2019-05-13","2019-05-11","2019-08-13","2019-02-28","2022-08-11","2019-05-03","2019-04-15","2019-04-15","2019-05-13","2019-05-10","2019-05-12","2019-05-23","2019-02-04","2019-02-04","2019-02-18","2019-02-04","2019-02-18","2019-02-18","2019-02-18","2019-02-18","2019-02-18","2019-05-12","2019-08-29","2019-11-14","2019-11-14","2019-01-18","2019-01-22","2019-01-22","2019-01-22","2019-02-18","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2019-02-04","2019-04-01","2019-04-01","2019-05-03","2022-09-21"],"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":{"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":[["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","ZOLPIDEM"," ZOLPIDEM ","14","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","120","Select","Select",""],["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","60","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","90","Select","Select",""],["","","LAMOTRIGINE"," LAMOTRIGINE ","30","Select","Select",""],["","","VENLAFAXINE"," VENLAFAXINE ","30","Select","Select",""],["","59267102503","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","16103038711","MECLIZINE","CHW 25MG","30","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","10","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","","NEO\/POLY\/HC","SUS 1% OTIC","","Select","Select",""],["","","CIPRODEX","SUS 0.3-0.1%","","Select","Select",""],["","","CIPRO\/DEXA","SUS 0.3-0.1%","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","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":""}]}]}