{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ALEGNAHTIMS L ","gend":1,"add":"RAG 1381TS TTER","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1973-04-08","age":"","mstatus":"","insh":"8762210*28","cliId":"","pno":"","cno":"","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":"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":["M43.16","M51.36","F11.20","G90.521","M47.816","G89.4","M96.1","M54.16","M54.42","G89.29","M54.5","J44.9","I25.2","I10.","F98.8","F41.9","F32.9","F31.9","K21.9","Z79.899","Z88.8","Z88.5","Z88.2","M79.671","NO DATA","N39.0","Z98.1","Z90.710","Z90.49","Z96.651","Z87.891","Z79.02","Z88.6","R30.0","L03.311","Z88.1","Z91.040","R50.9","R07.9","F17.210","M96.0","T84.226A","Z68.43","E11.9","Z79.84","E78.5","E66.01","M25.572","G54.4","M43.10","Z20.828","M54.41","M54.6","F34.1","M54.2","M54.9","S90.31XA","R53.1","I63.9","F17.201","G45.9","Z79.82","M19.90","Z01.818","Z47.89","Z85.42","L76.34","T81.89XA","S93.402A","S43.401A","R91.1","G47.33","T81.49XA","E66.9","T81.41XA","L03.312","L02.212","Z68.42","Z96.82","Z87.442","T81.40XA","A41.9","R22.2","R20.0","Z09.","R11.0","F41.1","Z82.49","Z79.891","R10.31","G47.00","J01.00","R89.9","S32.009K","T14.8XXA","L08.9","Z23.","I70.0","Z12.11","R61.","R73.03","M25.512","G47.30","G47.20","R06.83","Z72.0","F33.1","Z76.0","Z01.810","S39.012A","T84.63XA","J40.","Z87.2","Z86.010","R74.8","G62.9","I45.10","R07.82","R05.","D64.9","J44.1","Z71.1","F17.200","J42.","H53.9","R50.82","Z12.31","I08.1","F19.20","D36.7","N30.00","Z20.822","J06.9","M25.562","M22.2X2","T14.90XA","R69.","M46.36","Z45.2"],"date":["2021-07-28","2021-07-28","2022-09-28","2021-07-02","2021-07-02","2021-08-14","2021-07-15","2021-07-02","2021-06-05","2022-09-09","2021-07-15","2022-08-24","2021-06-05","2022-08-30","2021-06-05","2022-09-28","2021-07-24","2022-03-24","2022-06-17","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2021-10-12","2022-09-09","2022-03-24","2022-08-24","2022-03-24","2022-08-24","2022-08-24","2022-08-24","2022-06-17","2022-08-24","2022-08-19","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-06-17","2021-06-06","2020-06-02","2020-03-03","2021-07-24","2020-03-10","2020-03-03","2021-08-14","2022-03-03","2020-09-06","2020-10-28","2020-10-28","2021-12-25","2020-12-25","2020-12-25","2021-02-01","2021-04-15","2022-03-24","2021-06-15","2021-08-14","2021-08-14","2021-08-14","2022-09-09","2021-10-12","2021-10-12","2020-02-28","2020-03-10","2021-06-26","2020-06-02","2021-06-27","2020-08-31","2020-11-04","2021-06-09","2022-08-30","2021-07-28","2021-06-30","2021-07-24","2021-06-26","2021-06-26","2022-03-03","2021-06-26","2021-06-26","2021-07-28","2021-07-28","2021-07-26","2021-08-14","2022-09-09","2022-09-09","2021-08-18","2022-06-17","2022-06-17","2022-08-24","2022-08-30","2021-04-12","2021-07-15","2021-07-15","2021-07-27","2021-07-27","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-08-30","2022-08-30","2022-08-30","2021-06-03","2020-01-04","2021-04-14","2020-02-20","2020-08-15","2021-08-01","2022-04-28","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2020-01-20","2020-01-20","2021-05-31","2021-07-24","2020-01-03","2020-01-15","2021-05-09","2020-01-19","2021-05-19","2021-06-25","2021-07-07","2021-08-16","2021-08-31","2021-11-03","2022-08-01","2022-08-01","2021-12-25","2020-09-10","2020-09-10","2020-12-20","2020-12-20","2021-06-28","2021-07-26"],"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":[["","55111019605","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","29300015201","QUETIAPINE","TAB 400MG","90","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00378110101","PRAZOSIN","CAP 1MG","90","Select","Select",""],["","12496121203","SUBOXONE","MIS 12-3MG","5","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","90","Select","Select",""],["","72205002590","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","50228017805","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","57237010299","METOPROL","TAB 100MG","60","Select","Select",""],["","16729013600","CLONAZEPAM","TAB 0.5MG","14","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","31722073190","IRBESARTAN","TAB 300MG","90","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","00713057250","DOXYCYC","CAP 100MG","6","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","29300034301","BACLOFEN","TAB 10MG","90","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","3","Select","Select",""],["","00143980350","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","60","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","270","Select","Select",""],["","00406012401","HYDROCO\/APAP","TAB 7.5-325","90","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","5","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","10","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","21","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00904759082","FEROSUL","TAB 325MG","60","Select","Select",""],["","64980014612","FLORANEX","GRA ","28","Select","Select",""],["","08290236712","LACTINEX","GRA ","28","Select","Select",""],["","00536105429","ASPIRIN","TAB 325MG","90","Select","Select",""],["","47781035803","BUPREN\/NALOX","MIS 12-3MG","5","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","8","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","62332003131","ROPINIROLE","TAB 0.5MG","30","Select","Select",""],["","43598081112","CETIRIZINE","TAB 10MG","60","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","16","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","60","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","58160088552","FLUARIX","INJ 2020-21","0","Select","Select",""],["","50488200401","LIDOCAINE","PAD 0.04","5","Select","Select",""],["","60219106901","POT  CHLORIDE","TAB 20MEQ ER","9","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":""}]}]}