{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ID EILSELOZNATSOC","gend":1,"add":"A ELPPA 712H411 TPA EV","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1979-03-02","age":"","mstatus":"","insh":"8362210*26","cliId":"","pno":"77\/0892440-7","cno":"980\/777-0442","email":"","ename":"","eno":"","pphy":"MURDY, BRIANNA J PA","ppno":"757\/594-1850","pcpadd":"11803 JEFFERSON AVE STE 100","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R18.8","K72.90","K75.4","Z68.24","R11.2","R10.9","E83.42","N39.0","K70.31","I85.11","D62.","D50.9","R14.0","F10.10","I86.8","N18.9","K58.9","F32.9","F17.210","Z79.899","Z88.1","Z88.5","I85.00","T18.2XXA","F10.20","Z01.818","Z00.00","D68.59","K70.11","K74.60","K74.69","G93.40","R10.84","NO DATA","Z72.0","K52.9","G93.49","F33.41","R10.12","K76.6","K76.9","S61.459A","W54.0XXA","S61.452A","S62.512B","S61.012A","S61.412A","S71.152A","S70.12XA","Z20.3","Z29.14","T14.8XXA","Z99.11","R07.89","F10.129","R19.5","R74.0","E87.1","E87.2","K70.10","R60.0","Z87.440","K70.30","Z68.21","K70.40","I85.10","M62.81","R63.4","Z91.81","T78.40XA","K92.2","F17.209","R87.613","Z01.812","Z20.822","F41.8","I45.81","Z53.8","Z76.82","Z87.891","R10.32","K59.00","Z01.810","R10.30","R17.","K92.0","K92.1","E80.6","I85.01","K72.00","Z74.09","F43.21","Z65.8","Z01.419","Z13.89","N91.2","D06.1","E72.20","R41.82","Z09.","F17.200","Z68.29","Z76.0","I95.9","Z87.19","E87.6","N30.00","D68.69","G89.29","R93.2","D64.9","N17.9","K72.91","D61.818","F22.","R16.1","G47.00","Z23.","A41.9","R65.21","R94.31","R45.1","K26.9","D69.6","V58.89","R25.1","R79.82","D52.9","D51.9","K29.20","B95.2","R07.9","I51.7","A54.03","M79.661","M79.89","M79.662","K75.9","K76.7","D69.59","B96.89","D50.0","E86.0","K63.89","K55.9","E86.9","K31.89","I86.4","K72.10","I12.9","S62.512A","M20.012","W54.0XXD","Z98.890","K62.0","J96.01","E55.9","R93.3","F10.988","R05.","Z83.79","D72.829","R82.79","B96.20","R26.9","Z68.25","R07.81","S80.12XA","R74.8","R10.2","Z32.02","R82.998","R00.0","Z20.828","Z03.818","Z68.22","R19.8","F31.9","F05.","T42.8X5A"],"date":["2022-11-07","2022-10-07","2022-11-07","2020-03-16","2020-04-28","2021-11-21","2022-11-07","2021-08-20","2022-10-07","2022-11-07","2022-11-07","2021-06-03","2021-03-08","2022-11-07","2021-03-08","2022-11-07","2022-11-07","2021-08-16","2022-11-07","2021-03-16","2021-03-08","2022-09-18","2022-11-04","2021-04-22","2022-10-07","2022-08-03","2021-07-21","2022-11-04","2021-07-21","2022-10-13","2022-11-07","2022-10-13","2021-11-03","2022-10-07","2021-09-21","2021-11-21","2021-11-21","2022-11-04","2022-11-04","2022-02-18","2022-02-18","2022-08-08","2022-10-10","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-10-10","2022-10-10","2022-09-18","2022-09-18","2022-09-18","2022-10-07","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2022-08-03","2021-09-16","2021-06-03","2020-10-08","2020-10-08","2022-08-08","2021-05-12","2021-06-03","2021-11-19","2021-06-03","2021-06-03","2021-06-03","2021-04-22","2022-11-07","2021-04-22","2021-06-04","2021-06-29","2021-11-01","2022-11-07","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-18","2021-11-18","2022-10-11","2020-09-21","2021-03-08","2022-11-07","2021-03-09","2021-09-12","2022-10-13","2021-03-16","2021-03-16","2021-05-20","2021-05-20","2021-05-26","2021-05-26","2021-05-26","2021-06-30","2021-09-12","2021-11-19","2022-11-04","2022-08-08","2022-08-08","2022-08-08","2022-10-06","2022-10-06","2021-09-12","2021-08-18","2020-09-17","2020-09-17","2020-09-25","2021-03-11","2021-08-21","2021-08-18","2021-09-12","2021-09-12","2021-09-12","2021-09-12","2021-10-21","2021-11-20","2021-11-20","2022-10-13","2022-10-13","2022-11-07","2022-11-07","2022-11-07","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-06-13","2020-04-26","2020-08-31","2020-09-25","2020-09-25","2020-09-25","2021-08-16","2021-08-21","2022-10-07","2021-08-16","2021-08-16","2021-08-16","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2022-10-07","2021-11-19","2021-11-19","2022-08-03","2022-08-16","2022-08-16","2022-08-16","2022-10-06","2022-10-07","2020-02-03","2020-04-27","2020-04-27","2020-04-27","2020-04-27","2020-09-25","2021-03-12","2021-03-12","2021-03-12","2021-08-18","2021-09-29","2022-09-18","2020-03-11","2020-08-31","2020-08-31","2020-08-31","2020-09-17","2020-11-29","2020-11-25","2021-04-27","2021-11-18","2022-10-07","2022-10-07","2022-10-07"],"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":[["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","50383077932","LACTULOSE","SOL 10GM\/15","2838","Select","Select",""],["","68180013601","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","60","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","43547040110","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00115175701","CYPROHEPTAD","TAB 4MG","90","Select","Select",""],["","00363037606","ORAL","SPR 0.014","177","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","00536781708","OYSCO","TAB ","30","Select","Select",""],["","00135019502","NICODERM","DIS 14MG\/24H","28","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68382066201","SPIRONOLACT","TAB 100MG","30","Select","Select",""],["","57664037713","TRAMADOL","TAB 50MG","15","Select","Select",""],["","54838000650","VITAMIN","DRO 400UNIT","50","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","180","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","30","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","60","Select","Select",""],["","68462016205","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","9","Select","Select",""],["","65862014736","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","60","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00904546052","OYST","TAB 500MG","30","Select","Select",""],["","57896074206","CALCIUM\/D","TAB 500MG","30","Select","Select",""],["","70000041501","CLEARLAX","POW ","119","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00363193112","MILK","SUS 400\/5ML","75","Select","Select",""],["","68382073701","MIDODRINE","TAB 2.5MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","3","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","6","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","8","Select","Select",""],["","00121075908","PREDNISOLONE","SOL 15MG\/5ML","480","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","64679096401","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","64980052810","SODIUM","TAB 650MG","14","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":""}]}]}