{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARVIN   LEVESTER HENDRICKS JR","gend":0,"add":"4108 WHITE BEAM CT","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1981-03-18","age":"","mstatus":"","insh":"1697273*01","cliId":"","pno":"757\/805-2937","cno":"757\/805-2937","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":101283,"pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/805-2937","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9033","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","R79.89","E78.5","K70.31","K72.00","F10.20","E87.6","D68.9","E83.51","E83.42","E87.1","F19.10","D69.6","K70.11","F10.10","D64.9","R16.0","R18.8","R17.","K82.8","R09.02","R50.9","N52.9","K70.30","G62.9","K72.90","K59.00","K29.70","I85.10","K74.60","R40.4","R41.0","J01.00","K70.10","Z20.822","R44.3","F12.90","Z79.899","Z82.49","F33.1","R44.1","R03.0","Z20.828","G92.","F10.239","E72.20","K70.40","E87.70","D63.8","D69.59","F32.9","G93.41","F10.29","Z29.8","I85.00","K29.60","R20.0","J30.89","I70.0","D51.9"],"date":["2021-03-22","2020-04-20","2020-04-20","2020-11-25","2020-11-20","2020-11-25","2020-11-25","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2021-04-27","2020-11-16","2021-04-23","2020-11-12","2020-11-12","2020-11-06","2021-04-20","2020-11-06","2020-11-06","2020-11-06","2020-11-06","2021-03-22","2021-04-20","2021-04-13","2021-04-20","2021-04-20","2021-04-27","2021-04-27","2021-04-27","2020-01-20","2020-01-20","2020-08-19","2021-03-10","2021-04-23","2020-01-21","2020-01-21","2021-04-27","2021-04-27","2020-11-13","2020-01-20","2020-01-20","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-06","2020-11-20","2020-11-25","2021-04-27","2021-04-27","2020-01-14","2021-06-24","2020-11-08","2020-11-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","16714008211","HYDROXYZ","25MG","30","Select","Select",""],["","00121087316","LACTULOSE","10GM\/15","473","Select","Select",""],["","65649030302","XIFAXAN","550MG","60","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","90","Select","Select",""],["","53746051401","SPIRONOLACT","50MG","60","Select","Select",""],["","69097083305","SERTRALINE","25MG","30","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","60","Select","Select",""],["","00378064205","PREDNISONE","20MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","50383004248","PREDNISOLONE","15MG\/5ML","300","Select","Select",""],["","37000045904","PRILOSEC","20MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00168000680","TRIAMCINOLON","0.10%","80","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","00093534156","SILDENAFIL","25MG","10","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","21","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","-90","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65649030302","XIFAXAN ","550MG","60","Select","Select",""],["","00121075908","PREDNISOLONE ","15MG\/5ML","-100","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","30","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","16714071502","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00121087316","LACTULOSE ","10GM\/15","4050","Select","Select",""],["","59746021701","SPIRONOLACT ","50MG","30","Select","Select",""],["","68180035109","SERTRALINE ","25MG","30","Select","Select",""],["","37000045904","PRILOSEC ","20MG","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","-60","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","21","Select","Select",""],["","00093534156","SILDENAFIL ","25MG","10","Select","Select",""],["","00168000680","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","65862050320","AMOX\/K ","875-125","-20","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}