{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AILENROCECIR J  ","gend":1,"add":"NIGRIV E 201B TPA EVA AI","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1959-10-23","age":"","mstatus":"","insh":"93300210*23","cliId":"","pno":"03\/7578577-3","cno":"757\/726-3031","email":"","ename":"","eno":"","pphy":"FABIAN-GOTTLIEB, ARLENE P PA","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","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":["F33.1","R07.9","N39.3","N39.41","N39.490","R39.81","I10.","R73.03","T50.902S","E11.9","H25.13","H43.823","H35.462","N39.46","M79.3","L98.7","NO DATA","E87.6","M19.90","E78.2","I25.118","J45.20","I11.0","I50.9","N39.0","J44.9","I25.10","I25.2","G47.30","E66.01","Z68.43","Z86.711","Z98.84","Z86.010","Z90.49","Z96.651","Z82.49","Z87.891","Z88.5","R35.0","N39.44","M25.562","J30.89","J30.1","R09.82","J32.4","K21.9","J32.2","J32.1","J32.0","Z00.00","Z23.","E55.9","Z71.89","I83.029","L97.929","D69.6","E78.00","Z12.11","R20.2","M17.12","M25.561","Z01.411","Z12.12","R82.90","R82.998","R06.09","R73.09","Z11.59","F43.25","M15.0","R06.02","Z01.812","Z20.822","M17.0","J32.9","H35.40","H31.001","H43.811","G47.33","N95.0","R09.81","Z01.419","N90.9","Z99.89","Z32.02","Z01.810","I25.119","N84.0","R13.14","J37.0","R13.10","Z68.44","Z01.811","R68.89","D64.9","E78.5","E03.9","R06.9","R94.31","R03.0","H93.13","R42.","H90.3","M19.071","M19.072","B35.1","M24.571","M24.572","R60.1","M79.671","M79.672","H81.393","M25.511","M25.519","J31.0","H81.10","F17.210","R05.9","Z01.818","I50.32","I50.30"],"date":["2022-07-05","2021-03-16","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-08-19","2022-08-19","2022-04-04","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2022-08-11","2021-11-11","2021-07-29","2021-08-13","2021-08-13","2022-01-03","2022-08-05","2022-04-04","2022-04-14","2021-10-28","2021-10-28","2022-03-21","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2022-08-19","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2022-03-21","2021-12-29","2020-09-03","2022-03-23","2021-05-12","2022-03-02","2021-05-12","2022-03-02","2021-09-01","2021-06-03","2022-03-23","2021-06-09","2021-06-09","2022-08-19","2021-06-09","2022-04-04","2022-04-04","2022-08-19","2020-07-23","2021-03-12","2021-10-28","2022-07-14","2020-07-20","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-03-16","2021-03-26","2021-03-26","2020-04-08","2020-02-24","2020-11-05","2021-03-09","2021-03-09","2021-08-16","2022-04-14","2019-08-16","2019-08-16","2019-08-16","2019-03-06","2019-08-13","2019-05-16","2022-03-14","2019-08-13","2019-02-22","2019-06-17","2019-07-29","2019-07-29","2019-08-13","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2021-10-28","2022-03-23","2022-06-23","2022-03-23","2022-06-16","2022-05-17","2022-05-17","2022-06-16","2022-06-16","2022-06-16","2022-05-17","2022-05-17","2022-03-16","2022-08-19","2022-08-19","2022-04-14","2022-08-24","2022-04-14","2022-04-14","2022-01-03","2022-01-03","2022-04-04"],"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":[["","","TOVIAZ","TAB 8MG","","Select","Select",""],["","60505082701","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","00093681673","BUDESONIDE","SUS 0.5MG\/2","60","Select","Select",""],["","","MELOXICAM"," MELOXICAM ","30","Select","Select",""],["","73336007530","GEMTESA","TAB 75MG","30","Select","Select",""],["","","VENLAFAXINE"," VENLAFAXINE ","30","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","ISOSORB"," ISOSORB ","90","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","00781223410","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","","CLONIDINE"," CLONIDINE ","30","Select","Select",""],["","60505008302","PAROXETINE","TAB 20MG","30","Select","Select",""],["","","FUROSEMIDE"," FUROSEMIDE ","30","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","","METOPROL"," METOPROL ","60","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","","SIMVASTATIN"," SIMVASTATIN ","30","Select","Select",""],["","00832532311","POT  CHLORIDE","TAB 10MEQ ER","180","Select","Select",""],["","00781261301","AMOXICILLIN","CAP 500MG","4","Select","Select",""],["","67877006830","FESOTERODINE","TAB 8MG ER","30","Select","Select",""],["","49281042250","FLUZONE","INJ 2022-23","0","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","50","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00409120703","GENTAMICIN","INJ 40MG\/ML","10","Select","Select",""],["","51248015101","VESICARE","TAB 10MG","30","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","PREVNAR","INJ ","","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","","BOOSTRIX","INJ ","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","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":""}]}]}