{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRYANT   L TATEM","gend":0,"add":"3400 BREST AVE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1959-06-07","age":"","mstatus":"","insh":"1646623*01","cliId":"","pno":"757\/717-2638","cno":"757\/717-2638","email":"","ename":"","eno":"","pphy":"ANDERSON, ROBIN N MD","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/724-3800","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9772","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","I10.","E11.29","R80.9","Z79.4","K74.60","Z90.49","E11.9","H25.13","H02.051","H02.055","D50.9","K92.2","K92.1","E11.40","K21.9","K44.9","N40.0","E78.5","D50.0","E78.2","H93.13","E11.65","J01.90","K31.7","N40.1","N13.8","Z80.42","N52.1","R39.198","F51.01","K74.69","E66.01","D64.9","K31.819","R53.1","J98.9","R79.89","K29.50","Z12.5","K76.0","K91.89","Z12.11","R19.5","R06.02","E11.21","G47.30","Z83.3","Z88.0","Z88.8","R42.","H02.031","H02.034","K31.89","K29.70","R35.1","E66.9","Z68.34","Z18.89","R35.0","M1A.0720","Z78.9","R07.9","I63.9","E78.00","K75.81","Z98.890","Z79.899","Z82.49","Z20.828","D12.5","D63.8","Z01.812","Z20.822","K31.811","I78.1","K76.6","Z96.41","Z98.1","Z83.438","Z81.8","Z80.7","K76.9","K31.84","R55.","M20.32","T67.5XXA","N17.9","R77.8","M19.072","G25.81","L98.499","Z68.35","Z79.82","Z99.89","I20.8","I95.9","R11.0","I12.9","N18.30","E11.22","D63.1","E11.42","G47.33","I65.23","I50.9","Z00.00","J02.9","R09.81","R91.8"],"date":["2021-10-13","2021-11-24","2021-06-07","2021-06-07","2021-09-30","2021-11-05","2021-09-17","2021-07-28","2020-12-18","2020-12-18","2020-12-18","2021-11-05","2021-03-27","2021-03-26","2021-11-24","2021-11-24","2021-03-27","2021-10-05","2021-09-30","2021-09-30","2021-06-07","2021-06-07","2021-11-24","2020-03-27","2020-08-31","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-03-03","2021-11-24","2021-03-03","2021-03-03","2021-05-26","2021-11-05","2021-03-18","2021-03-18","2021-10-05","2021-03-25","2021-03-31","2021-10-05","2021-11-05","2020-08-25","2021-02-12","2021-10-05","2021-10-07","2021-10-07","2021-05-26","2021-10-07","2021-10-07","2021-10-13","2021-02-04","2021-02-04","2021-03-25","2021-03-25","2021-03-25","2021-09-30","2021-05-26","2021-03-25","2020-01-08","2021-11-24","2020-09-01","2021-10-07","2021-03-18","2021-05-26","2021-09-30","2021-09-30","2021-09-30","2021-05-26","2021-09-28","2021-02-23","2021-03-31","2021-05-19","2021-05-19","2021-09-30","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-04-09","2021-07-23","2021-11-05","2021-08-16","2021-08-16","2021-10-13","2021-10-06","2021-10-21","2021-10-21","2021-10-21","2021-09-30","2021-09-30","2021-09-30","2021-10-05","2021-10-07","2021-10-07","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-11-05","2021-10-05","2021-11-24","2021-09-28","2021-09-28","2021-10-04"],"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,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":[["","68382005101","MELOXICAM ","15MG","90","Select","Select",""],["","68462034690","LEVOCETIRIZI ","5MG","180","Select","Select",""],["","00169750111","NOVOLOG ","100\/ML","-20","Select","Select",""],["","08560940001","V-GO ","","30","Select","Select",""],["","71093011205","GABAPENTIN ","800MG","-270","Select","Select",""],["","60505014601","OMEPRAZOLE ","40MG","180","Select","Select",""],["","00591279086","TIZANIDINE ","6MG","-90","Select","Select",""],["","31722071130","SILDENAFIL ","100MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","360","Select","Select",""],["","65862020330","LOSARTAN ","100MG","90","Select","Select",""],["","00591554301","ALLOPURINOL ","100MG","90","Select","Select",""],["","59762305102","AZITHROMYCIN ","1GM PAK","1","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","65862016001","ZOLPIDEM ","10MG","30","Select","Select",""],["","59762045001","COLESTIPOL ","1GM","-180","Select","Select",""],["","73070010011","INSULIN ","100\/ML","20","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1","Select","Select",""],["","00904759161","FERROUS ","325MG","90","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","51672400102","NORTRIPTYLIN ","10MG","30","Select","Select",""],["","64380076921","PEG-3350\/KCL ","\/SODIUM","4000","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","68462034690","LEVOCETIRIZI","5MG","-180","Select","Select",""],["","08560940001","V-GO","","-30","Select","Select",""],["","68382005101","MELOXICAM","15MG","90","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","20","Select","Select",""],["","60505265007","TIZANIDINE","6MG","90","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","90","Select","Select",""],["","71093011205","GABAPENTIN","800MG","270","Select","Select",""],["","60505014601","OMEPRAZOLE","40MG","-180","Select","Select",""],["","31722071130","SILDENAFIL","100MG","30","Select","Select",""],["","62756014202","METFORMIN","500MG ER","360","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","65862020330","LOSARTAN","100MG","90","Select","Select",""],["","00591554301","ALLOPURINOL","100MG","90","Select","Select",""],["","59762305102","AZITHROMYCIN","1GM PAK","1","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","59762045001","COLESTIPOL","1GM","180","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","73070010011","INSULIN","100\/ML","20","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","64380076921","PEG-3350\/KCL","\/SODIUM","4000","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00904759161","FERROUS","325MG","90","Select","Select",""],["","51672400102","NORTRIPTYLIN","10MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","59762040101","SUCRALFATE","1GM","56","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","68382012305","AMLODIPINE","10MG","90","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","-21","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","56","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","7","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","21","Select","Select",""],["","68382056401","METOPROL ","TAB 25MG ER","90","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","68382012305","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","29300041301","CYCLOBENZAPR ","TAB 5MG","10","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":""}]}]}