{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAWN   R HOPPER","gend":1,"add":"7934 THOMPSON RD UNIT A","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1971-06-27","age":"","mstatus":"","insh":"1703702*01","cliId":"","pno":"757\/450-4889","cno":"757\/450-4889","email":"","ename":"","eno":"","pphy":"ROBLEDO, ELIZABETH MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9004","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N17.0","I10.","E83.52","D64.9","E11.9","E78.5","R06.00","R07.89","R00.0","N17.9","E11.65","R73.9","E66.9","Z79.4","T38.0X5A","I42.9","Z71.9","D86.9","I50.9","R06.02","R60.1","E11.69","R59.0","D86.2","I50.22","E55.9","R20.2","R91.8","N19.","I08.1","I50.21","N18.4","Z12.31","E78.2","R10.9","J45.20","Z79.899","Z79.84","Z79.82","Z88.5","E78.00","I11.0","E87.6","R09.81","E83.42","J90.","J81.1","Z23.","I08.8","D89.89","E66.01","Z68.35","A08.4","D63.1","C85.90","Z96.41","F51.01","R16.2","Z20.822","I89.8","R59.1","R53.83","Z09.","E28.2","E86.9","I51.7","I51.9","I51.89"],"date":["2020-10-06","2021-01-02","2021-10-28","2020-10-05","2021-03-04","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2021-05-15","2021-07-12","2021-07-12","2021-08-30","2021-07-12","2021-07-12","2020-12-30","2021-08-30","2021-08-28","2021-04-20","2020-10-04","2020-10-04","2020-10-07","2021-01-14","2021-08-12","2021-02-04","2020-10-19","2020-10-28","2021-01-14","2020-09-30","2020-10-05","2020-10-12","2021-08-30","2021-09-21","2021-01-02","2020-09-28","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-10-04","2020-10-04","2020-10-28","2021-02-04","2021-06-22","2020-06-26","2020-06-26","2020-07-31","2020-10-04","2020-10-05","2021-03-04","2021-02-12","2021-01-14","2021-01-27","2021-08-28","2020-10-05","2020-10-05","2020-10-12","2021-02-04","2020-09-29","2021-08-12","2021-08-12","2021-08-12"],"priorHcc":["","",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":[["","53885000810","ONETOUCH","PLUS 33G","-100","Select","Select",""],["","68645055854","LISINOP\/HCTZ","20-25MG","90","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","2","Select","Select",""],["","68645058459","METFORMIN","1000MG","180","Select","Select",""],["","00002879959","HUMALOG","100\/ML","-15","Select","Select",""],["","08290324909","INSULIN","0.3\/31G","-100","Select","Select",""],["","00088222033","LANTUS","100\/ML","30","Select","Select",""],["","00193731025","CONTOUR","NEXT","100","Select","Select",""],["","59746017310","PREDNISONE","10MG","-30","Select","Select",""],["","64980052810","SODIUM","650MG","120","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","180","Select","Select",""],["","00193658621","MICROLET","LANCETS","200","Select","Select",""],["","68180046703","LOVASTATIN","10MG","90","Select","Select",""],["","00193654621","BAYER","LANCETS","200","Select","Select",""],["","50111056001","TRAZODONE","50MG","60","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","90","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","13","Select","Select",""],["","68382009505","CARVEDILOL","25MG","60","Select","Select",""],["","43598072101","HYDROXYCHLOR","200MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","20","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","10","Select","Select",""],["","49348081705","ACID","20MG","30","Select","Select",""],["","00193730850","","","100","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","68645055854","LISINOP\/HCTZ ","20-25MG","90","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","-2","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","68645058459","METFORMIN ","1000MG","180","Select","Select",""],["","00088502101","LANTUS ","100\/ML","-10","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","15","Select","Select",""],["","68382009401","CARVEDILOL ","12.5MG","60","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","13","Select","Select",""],["","08290328440","INSULIN ","0.3\/31G","100","Select","Select",""],["","49348081705","ACID ","20MG","30","Select","Select",""],["","59746017506","PREDNISONE ","20MG","90","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","90","Select","Select",""],["","68180046703","LOVASTATIN ","10MG","90","Select","Select",""],["","00193654621","BAYER ","LANCETS","200","Select","Select",""],["","00193658621","MICROLET ","LANCETS","200","Select","Select",""],["","64980052810","SODIUM ","650MG","120","Select","Select",""],["","00193731150","CONTOUR ","NEXT","150","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","43598072101","HYDROXYCHLOR ","200MG","60","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","90","Select","Select",""],["","57237007810","ONDANSETRON ","8MG ODT","10","Select","Select",""],["","50111056001","TRAZODONE ","50MG","60","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","08627001601","DEXCOM ","TRANSMIT","1","Select","Select",""],["","81131038679","RELION ","32GX4MM","-50","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","20","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","08627001601","DEXCOM","TRANSMIT","1","Select","Select",""],["","81131038679","RELION","32GX4MM","50","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","-1","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":""}]}]}