{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MILLIE   L RESHAY","gend":0,"add":"939 21ST ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1964-02-05","age":"","mstatus":"","insh":"1718324*01","cliId":"","pno":"757\/320-9396","cno":"757\/320-9396","email":"","ename":"","eno":"","pphy":"BROOKS, BONNIE J MD","ppno":"757\/594-1803","pcpadd":"SUITE 140 1183 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":119865,"pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/589-0830","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9226","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","Z99.2","E11.9","I10.","B20.","J40.","N63.20","K59.00","E78.00","N18.9","I50.9","R05.","R06.02","E11.22","I13.2","R42.","R07.89","R11.0","Z21.","Z87.891","J45.909","Z79.899","Z79.4","I12.9","R60.9","E66.9","E78.5","R60.0","Z20.828","E87.8","J96.00","U07.1","I12.0","E87.70","T82.598A","T82.49XA","J44.9","F32.9","E66.09","Z68.36","Z82.49","Z83.3","Z86.19","J81.0","R09.02","J96.01","I50.33","I50.43","Z99.3","D63.1","M79.605","M79.604","E66.3","Z68.35","M79.89","R06.00","F64.0","N63.10","N64.89","R53.81","R53.83","R68.83","G25.81","J12.82","J44.0","T37.5X5S","I16.0","D64.9","E66.01","K74.60","R50.9","J45.20","G47.30","B19.20","R14.1","K21.9","I45.89","Z12.5","N62.","I31.3","I27.20","I51.7","R65.10","Z68.37","T82.9XXA","R79.89","Z91.19","R06.89","Z20.822","R07.9","R79.1","J81.1","Z03.89","I11.0","N19.","R00.0","I25.2","J15.9","N25.81","G47.33","B18.2","Z12.11","Z68.38","R18.8","M53.3","T14.90XA","H10.33","K62.5","S30.0XXA","F51.3","Z79.1","K92.1","T82.898A","Z23.","M54.9","J18.9","L29.9","M54.2","M19.012","R22.1","E87.5","R91.8","M25.512","M19.90","J98.11","J90.","I35.8","R05.9","Z91.15","I70.0","J18.1","R06.03","F64.9"],"date":["2021-10-31","2021-10-31","2021-10-26","2021-10-28","2021-10-26","2021-03-09","2020-05-28","2021-10-26","2021-10-26","2021-05-14","2021-10-26","2020-12-29","2021-10-11","2021-10-28","2021-10-04","2020-01-14","2021-05-31","2020-01-14","2021-09-20","2021-10-12","2021-09-20","2021-09-20","2021-09-20","2020-08-11","2020-08-11","2021-10-04","2021-10-28","2020-08-11","2020-12-14","2021-10-11","2021-02-09","2021-02-13","2021-10-12","2021-02-11","2021-07-27","2021-07-27","2021-10-26","2021-10-26","2020-10-14","2021-09-23","2020-10-14","2020-10-14","2021-08-31","2021-01-22","2021-01-21","2021-10-12","2021-07-20","2021-02-08","2021-02-13","2021-10-07","2021-05-14","2021-05-14","2021-05-14","2021-05-14","2021-05-14","2021-10-07","2021-01-25","2020-05-28","2020-05-28","2020-08-01","2020-08-01","2020-12-29","2021-09-03","2021-01-22","2021-10-04","2021-05-04","2021-01-19","2021-01-22","2021-10-28","2021-10-04","2021-10-04","2021-09-23","2021-09-23","2021-01-25","2021-03-09","2021-10-28","2021-07-20","2021-08-03","2020-05-28","2021-10-04","2020-11-10","2021-10-12","2021-02-05","2021-10-28","2021-05-31","2021-05-31","2020-08-04","2021-01-19","2021-10-04","2021-05-31","2021-05-31","2021-10-06","2021-02-10","2021-05-04","2021-10-26","2021-01-19","2021-01-19","2021-02-05","2021-10-07","2021-10-28","2021-10-04","2021-05-23","2021-08-25","2021-09-23","2021-09-03","2021-09-03","2021-09-20","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-05-31","2021-08-31","2021-08-31","2021-10-26","2021-10-26","2021-10-26","2021-10-07","2021-10-10","2021-10-09","2021-10-12","2021-10-10","2021-10-10","2021-10-04","2021-10-04","2021-10-04","2021-10-11","2021-10-11","2021-10-06","2021-10-04","2021-10-04","2021-10-04"],"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":[["","49702024213","JULUCA","50-25MG","-30","Select","Select",""],["","13668010501","ISOSORB","60MG ER","-30","Select","Select",""],["","65862057490","MONTELUKAST","10MG","-30","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","-90","Select","Select",""],["","68180063709","ATORVASTATIN ","40MG","90","Select","Select",""],["","00002751101","HUMALOG ","75\/25","10","Select","Select",""],["","67877019905","AMLODIPINE ","10MG","30","Select","Select",""],["","49702024213","JULUCA ","50-25MG","-30","Select","Select",""],["","57237000830","MIRTAZAPINE ","15MG","30","Select","Select",""],["","50111039701","HYDRALAZINE ","100MG","90","Select","Select",""],["","45802049326","AMMONIUM ","12%","385","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","13668010501","ISOSORB ","60MG ER","30","Select","Select",""],["","68382009201","CARVEDILOL ","3.125MG","60","Select","Select",""],["","00173087310","INCRUSE ","62.5MCG","-90","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","8","Select","Select",""],["","00378581477","VALSARTAN ","160MG","-30","Select","Select",""],["","00173068220","VENTOLIN ","","-54","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","90","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","30","Select","Select",""],["","00093506101","HYDROXYZ ","25MG","-90","Select","Select",""],["","11822054311","RA ","10MG","30","Select","Select",""],["","00781208102","CALC ","667MG","90","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","-128","Select","Select",""],["","00527512570","LACTULOSE ","10GM\/15","450","Select","Select",""],["","00093735301","CALCITRIOL ","0.5MCG","-90","Select","Select",""],["","45802065078","LORATADINE ","10MG","45","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","14","Select","Select",""],["","68382080501","TRAZODONE ","50MG","90","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","14","Select","Select",""],["","08290328438","INSULIN ","0.3\/31G","-60","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","11822317370","TUSSIN ","10-100\/5","236","Select","Select",""],["","00121077516","GG\/CODEINE ","100-10\/5","236","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","2.5-2.5%","60","Select","Select",""],["","60258016101","RENA-VITE ","","30","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","60","Select","Select",""],["","72888001405","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","54295030815","UREA ","40%","57","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","240","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","65162005827","SEVELAMER ","800MG","180","Select","Select",""],["","11822333060","ACID ","10MG","90","Select","Select",""],["","67877022001","CEPHALEXIN ","250MG","14","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","7","Select","Select",""],["","29300013505","CLONIDINE ","0.1MG","60","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","11822330080","GAS ","125MG","90","Select","Select",""],["","57237010101","METOPROL ","50MG","60","Select","Select",""],["","69543038810","KETOROLAC ","10MG","15","Select","Select",""],["","60505258009","ATORVASTATIN","40MG","30","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","30","Select","Select",""],["","50111039701","HYDRALAZINE","100MG","90","Select","Select",""],["","68382009201","CARVEDILOL","3.125MG","60","Select","Select",""],["","00002751101","HUMALOG","75\/25","20","Select","Select",""],["","60432060416","PROMETHAZINE","DM","240","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","54295030815","UREA","40%","57","Select","Select",""],["","67877019905","AMLODIPINE","10MG","-30","Select","Select",""],["","45802049326","AMMONIUM","12%","385","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","30","Select","Select",""],["","00781208102","CALC","667MG","90","Select","Select",""],["","08290328438","INSULIN","0.3\/31G","60","Select","Select",""],["","11822317370","TUSSIN","10-100\/5","236","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","14","Select","Select",""],["","60505265301","TRAZODONE","50MG","90","Select","Select",""],["","11822333230","RA","100-10\/5","118","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00173087310","INCRUSE","62.5MCG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","60258016101","RENA-VITE","","30","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","90","Select","Select",""],["","00173068220","VENTOLIN","","54","Select","Select",""],["","11822316450","LORATADINE","10MG","100","Select","Select",""],["","00093735301","CALCITRIOL","0.5MCG","90","Select","Select",""],["","33342006410","VALSARTAN","160MG","30","Select","Select",""],["","57237000830","MIRTAZAPINE","15MG","30","Select","Select",""],["","00527512570","LACTULOSE","10GM\/15","450","Select","Select",""],["","00121077504","GG\/CODEINE","100-10\/5","236","Select","Select",""],["","29300013505","CLONIDINE","0.1MG","60","Select","Select",""],["","11822330080","GAS","125MG","90","Select","Select",""],["","57237010101","METOPROL","50MG","60","Select","Select",""],["","00173085910","BREO","100-25","-60","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","00143992701","CIPROFLOXACN","250MG","14","Select","Select",""],["","50383066730","LIDO\/PRILOCN","2.5-2.5%","-30","Select","Select",""],["","69543038810","KETOROLAC","10MG","15","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","128","Select","Select",""],["","67877022001","CEPHALEXIN","250MG","14","Select","Select",""],["","70010075401","METHOCARBAM","500MG","60","Select","Select",""],["","00093506101","HYDROXYZ","25MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5%","-30","Select","Select",""],["","72888001405","CYCLOBENZAPR","10MG","60","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","7","Select","Select",""],["","65162005827","SEVELAMER","800MG","180","Select","Select",""],["","17478007035","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","11822333060","ACID","10MG","90","Select","Select",""],["","17478030512","OLOPATADINE","0.20%","2","Select","Select",""],["","55111027950","LEVOFLOXACIN","250MG","2","Select","Select",""],["","11822307820","ATHLETE","1%","30","Select","Select",""],["","41167005840","ASPERCREME","LIDO 4%","10","Select","Select",""],["","60432053716","NYSTATIN","100000","200","Select","Select",""],["","11822307820","ATHLETE ","CRE 0.01","30","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","200","Select","Select",""],["","41167005840","ASPERCREME ","PAD LIDO 4%","10","Select","Select",""],["","31722095801","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","17478007035","ERYTHROMYCIN ","OIN 5MG\/GM","4","Select","Select",""],["","55111027950","LEVOFLOXACIN ","TAB 250MG","2","Select","Select",""],["","17478030512","OLOPATADINE ","SOL 0.002","2","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":""}]}]}