{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LREBMIKECYOB Y","gend":1,"add":"ELTTIL 3753DAOR KEERC ","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1963-05-14","age":"","mstatus":"","insh":"9260210*42","cliId":"","pno":"73\/7574739-7","cno":"757\/377-9374","email":"","ename":"","eno":"","pphy":"LIPTON, ERIC MD","ppno":"757\/363-6848","pcpadd":"SUITE 100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Independence","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":["J20.9","R05.","J44.9","J44.1","F17.200","J45.20","J18.9","G47.33","R05.9","R09.02","Z20.828","J42.","Z20.822","NO DATA","K46.9","F17.210","M54.16","B34.9","K43.9","R53.83","J98.01","M54.12","R10.9","J44.0","R06.2","F41.9","F41.0","G47.31","R40.0","Z72.821","G47.00","G47.61","Z79.899","Z91.041","Z88.8","Z91.018","Z85.3","J45.909","Z88.1","K43.0","E66.9","Z68.36","K21.9","Z90.10","Z80.3","Z82.49","Z82.3","Z82.61","Z83.49","Z03.818","J12.9","Z87.01","R69.","R06.02","M54.41","A41.9","J96.01","J43.9","Z90.11","R52.","C50.912","J41.1","R06.00"],"date":["2022-09-21","2021-09-20","2022-09-21","2021-11-08","2022-09-21","2021-09-20","2021-10-05","2022-09-21","2022-09-21","2022-05-16","2020-09-26","2020-09-26","2021-09-16","2022-07-09","2022-07-09","2022-07-09","2021-10-21","2021-12-30","2022-07-08","2021-02-10","2021-10-05","2020-01-15","2021-12-15","2020-06-15","2020-04-14","2022-07-09","2020-06-15","2020-06-09","2020-06-09","2020-06-09","2020-09-25","2020-06-09","2021-10-21","2022-07-09","2021-10-21","2021-10-21","2022-07-09","2021-10-21","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2022-07-09","2020-04-17","2020-09-27","2020-10-06","2020-10-06","2021-09-16","2021-12-17","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2021-02-10","2020-09-26","2021-09-16","2021-12-15"],"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":[["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","76204010025","IPRATROPIUM","SOL 0.02%INH","125","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","30","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","118","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","62542030117","HYD","SUS 10-8\/5ML","240","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","100","Select","Select",""],["","50383008716","GUAIATUSS","SYP 100-10\/5","100","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","00310460012","BEVESPI","AER 9-4.8MCG","11","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","60","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","90","Select","Select",""],["","00093553801","ESZOPICLONE","TAB 2MG","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","120","Select","Select",""],["","00140000501","VALIUM","TAB 5MG","16","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","540","Select","Select",""],["","00115168974","BUDESONIDE","SUS 0.5MG\/2","60","Select","Select",""],["","00904698640","MUCUS","TAB 600MG ER","10","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","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":""}]}]}