{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN   M MALANA","gend":1,"add":"4449 HINSDALE ST","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1968-04-06","age":"","mstatus":"","insh":"1607663*01","cliId":"","pno":"757\/619-3170","cno":"757\/619-3170","email":"","ename":"","eno":"","pphy":"WOODS, DAVID W MD","ppno":"757\/363-6800","pcpadd":"#100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":101283,"pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9029","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.9","K57.32","E11.9","D68.2","I10.","F17.210","E66.01","Z68.33","Z88.1","Z88.0","Z88.8","R11.2","R09.89","R55.","J01.40","J45.20","J30.1","T82.9XXA","R07.1","T82.120A","T82.190A","K21.9","Z68.35","Q24.8","E87.6","F32.9","M53.1","Z87.11","Z95.0","J98.11","I51.7","D68.51","I26.90","I26.99","Z79.01","Z20.828","M79.10","R07.0","G47.33","F43.10","F32.4","I44.1","R00.2","J01.41","H65.01","R05.","Z72.0","Z23.","R51.","G54.2","R06.00","R07.89","R07.9","I30.9","T82.120S","T82.110D","R53.83","M54.9","T82.9XXD","R42.","E87.1","R00.1","Z83.2","Z95.810","I87.2","R60.9","R52.","I26.93","G40.909","D72.829","E86.1","K58.0","Z86.79","F32.1","G25.81","Z46.82","Z45.018","R03.0","R06.02","M94.0","R60.0","M79.89","I34.0","I37.1","I44.2","Z87.891","Z88.3","R11.0","R06.09","Z86.711","Z68.34","Z87.19","Z86.2","Z86.59","E66.9","I25.10","F17.290","Z79.899","I35.9","I31.3","Z82.0","G47.01","R06.83","F41.1","R00.0","R51.9","R35.0","E78.2","F32.5","J30.89","R73.03","H43.812","Z83.511","Z83.518","I47.1","R91.1","F17.200","Z11.4","Z11.59","R10.10","R91.8","R10.12","R19.7","G47.9","R10.13","R50.9","J32.9","H10.33","Z12.11","I48.0","I49.5","M25.50","E11.65","E78.5"],"date":["2020-04-08","2021-09-29","2020-06-15","2021-09-29","2020-11-17","2021-11-16","2021-09-29","2021-11-16","2021-06-28","2021-09-29","2021-09-29","2021-09-29","2020-06-15","2021-06-03","2021-09-29","2020-11-17","2021-03-19","2020-11-17","2020-11-16","2020-11-16","2020-11-17","2020-11-17","2021-11-16","2021-11-16","2020-11-17","2021-11-16","2021-09-29","2020-11-17","2021-11-16","2021-11-01","2020-11-17","2020-11-18","2021-11-16","2020-12-30","2021-07-14","2021-01-14","2021-01-27","2021-08-20","2021-01-27","2021-11-16","2021-04-03","2021-06-03","2021-11-16","2021-10-07","2020-03-16","2020-03-16","2020-03-16","2021-11-16","2021-09-29","2020-09-25","2020-09-25","2020-10-05","2021-09-29","2021-10-07","2020-12-21","2020-11-23","2020-12-16","2020-12-28","2021-01-13","2020-11-28","2021-04-13","2021-10-07","2021-11-01","2020-12-21","2020-12-21","2020-12-30","2020-12-30","2021-01-19","2020-11-27","2021-09-29","2021-08-20","2020-11-27","2020-11-27","2021-04-13","2020-10-08","2020-10-08","2020-11-13","2020-11-13","2020-11-16","2020-11-16","2021-01-14","2021-02-22","2021-02-22","2021-09-30","2020-10-06","2020-11-25","2020-11-16","2020-11-16","2021-06-28","2021-04-13","2021-07-14","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2020-10-05","2020-11-16","2020-11-13","2020-11-16","2020-11-27","2020-11-29","2021-01-20","2021-01-20","2020-12-28","2021-01-14","2021-01-14","2021-07-20","2021-02-11","2021-11-16","2021-11-16","2021-08-19","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-09-29","2021-07-14","2021-07-10","2021-07-20","2021-07-20","2021-06-30","2021-07-10","2021-06-28","2021-06-28","2021-07-20","2021-06-28","2021-08-20","2021-08-19","2021-08-19","2021-08-30","2021-09-29","2021-09-29","2021-11-16","2021-11-16","2021-09-29"],"priorHcc":["",null,"",null,"",null,null,null,"",null,null,null,"","",null,"","","","","","","",null,null,"",null,null,"",null,null,"","",null,"","","","","","",null,"","",null,null,"","","",null,null,"","","",null,null,"","","","","","","",null,null,"","","","","","",null,"","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","",null,null,"","","","","",null,"","","","","","","","","","","","","",null,null,null,null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00228202750","ALPRAZOLAM","0.25MG","60","Select","Select",""],["","60505367903","CARVEDILOL","20MG ER","30","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","00143301801","COLCHICINE","0.6MG","-30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","-90","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","40","Select","Select",""],["","00591544210","PREDNISONE","10MG","30","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","-30","Select","Select",""],["","65162010250","GABAPENTIN","300MG","90","Select","Select",""],["","43547041309","QUINAPRIL","40MG","30","Select","Select",""],["","43547029010","BUPROPION","200MG SR","60","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","68180071160","CEFDINIR","300MG","-20","Select","Select",""],["","65162024709","CHLORTHALID","25MG","90","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN","750MG","10","Select","Select",""],["","00378001805","METOPROL","25MG","180","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","64380080807","IBUPROFEN","600MG","14","Select","Select",""],["","59762040101","SUCRALFATE","1GM","30","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","60","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","30","Select","Select",""],["","60505367903","CARVEDILOL ","20MG ER","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","15","Select","Select",""],["","65862053820","LEVOFLOXACIN ","750MG","10","Select","Select",""],["","68180055409","QUINAPRIL ","40MG","-180","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","-53","Select","Select",""],["","43547029010","BUPROPION ","200MG SR","60","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48","Select","Select",""],["","68180071160","CEFDINIR ","300MG","-20","Select","Select",""],["","00143301801","COLCHICINE ","0.6MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","00003089421","ELIQUIS ","5MG","74","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","-90","Select","Select",""],["","00591505210","PREDNISONE ","5MG","-30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","-30","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","40","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","65162024709","CHLORTHALID ","25MG","-30","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","-90","Select","Select",""],["","65862001205","SERTRALINE ","50MG","30","Select","Select",""],["","00378001805","METOPROL ","25MG","60","Select","Select",""],["","62037099901","POT  CL MICRO","20MEQ ER","30","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","14","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","30","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","62037099901","POT CL MICRO","20MEQ ER","-30","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","00378718505","METFORMIN","500MG","60","Select","Select",""],["","00378718505","METFORMIN ","TAB 500MG","180","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}