{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLAUDIA   L DELANEY","gend":1,"add":"2104 PRINCESS ANNE CT","city":"VIRGINIA BEACH","state":"VA","zip":"23457-9998","dob":"1957-07-25","age":"","mstatus":"","insh":"3136345*01","cliId":"","pno":"757\/426-5203","cno":"757\/426-5203","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":"757\/420-9003","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":["M35.00","M79.10","E78.00","R55.","R79.89","F41.9","M75.122","G89.4","H25.813","H40.1121","H40.1112","H16.223","Z96.1","H25.811","S01.111D","Z48.02","S09.90XD","S40.011D","M75.81","W19.XXXD","Z01.818","Z20.828","M19.011","M19.019","K21.9","J45.20","M25.511","Z96.611","Z47.1","M25.512","G89.29","M12.811","M25.611","M75.101","S01.81XA","S09.90XA","M75.121","M19.012","H40.9","E78.5","Z79.899","Z79.1","Z88.6","Z88.5","Z88.2","Z90.710","I49.3","R06.02","H25.9","H53.8","M70.61","M70.62","M25.551","M25.552","M25.60","S46.912A","S46.911A","W19.XXXA","H00.011","G47.00","L08.9","M71.21","Z79.891","R25.2","Z23.","R40.2362","R40.2142","R40.2252","Z91.048","Z82.49","Z88.8","R51.","R00.2","R03.0","J30.1","I73.00","N95.9","E04.2","M26.609","M62.50","N39.0","R33.9","R35.0","Z91.09","R42.","T14.90XA","J32.9","H69.82","H92.02","S43.402A","S46.012A","S46.112A","S43.431A","S46.011A","S43.021A","S46.111A","R29.898","Z98.890","S46.811A","M75.51","M75.52","M75.82","M94.8X1","R79.1","R07.9","H25.812","J01.01","J40.","R05.","J45.21","H25.11","F11.20","Z51.81","H04.121","H04.122","T14.8XXA"],"date":["2021-10-13","2021-03-05","2021-09-13","2021-03-19","2021-03-19","2021-09-13","2021-03-19","2021-09-13","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-06-10","2021-07-13","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-06-26","2020-05-29","2021-05-21","2020-11-12","2021-03-05","2020-11-17","2021-09-13","2021-10-13","2021-03-03","2021-06-30","2021-06-30","2021-09-03","2021-09-03","2020-11-16","2020-11-16","2020-11-16","2020-05-22","2020-05-22","2020-11-16","2020-09-11","2021-09-13","2020-11-16","2020-11-16","2020-11-16","2021-03-13","2021-03-13","2021-03-13","2020-11-16","2021-03-14","2021-03-14","2021-05-21","2021-05-21","2020-02-14","2020-01-14","2020-02-14","2020-01-14","2020-06-12","2020-06-12","2020-06-26","2020-06-12","2020-08-03","2020-08-03","2021-11-15","2020-08-03","2020-08-20","2020-02-14","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2021-03-13","2020-05-22","2020-07-17","2020-07-17","2021-10-13","2021-09-13","2021-03-05","2021-09-13","2020-08-20","2020-10-28","2020-12-03","2020-12-03","2020-12-03","2021-03-13","2021-03-13","2020-05-22","2021-10-13","2021-03-31","2021-03-31","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-07-17","2021-01-04","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2021-03-13","2021-03-13","2021-06-08","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-07-13","2021-09-13","2021-09-13","2021-08-27","2021-08-27","2021-11-15"],"priorHcc":[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":[["","65162062711","TRAMADOL","50MG","42","Select","Select",""],["","70010077001","METHOCARBAM","750MG","60","Select","Select",""],["","13811071910","NITROFURANTN","100MG","20","Select","Select",""],["","65862057490","MONTELUKAST","10MG","-90","Select","Select",""],["","68462062030","COLESEVELAM","3.75","-30","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","40","Select","Select",""],["","31722088290","ROSUVASTATIN","5MG","90","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00781106110","ALPRAZOLAM","0.25MG","-30","Select","Select",""],["","17478030703","AZASITE","1%","2","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","45","Select","Select",""],["","59762033302","LATANOPROST","0.01%","8","Select","Select",""],["","00574402235","BACITRACIN","OP","4","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","54092060601","XIIDRA","5%","180","Select","Select",""],["","65862017760","CEFDINIR","300MG","-20","Select","Select",""],["","69097052444","DICLOFENAC","1%","1000","Select","Select",""],["","65862018730","ONDANSETRON","4MG","12","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","60","Select","Select",""],["","65162062711","TRAMADOL ","50MG","240","Select","Select",""],["","68462062030","COLESEVELAM ","3.75","-30","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","20","Select","Select",""],["","69097052444","DICLOFENAC ","1%","-1000","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","-90","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","40","Select","Select",""],["","54092060601","XIIDRA ","5%","180","Select","Select",""],["","59762371901","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","31722088290","ROSUVASTATIN ","5MG","90","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","17478030703","AZASITE ","1%","2","Select","Select",""],["","00574402235","BACITRACIN ","OP","-4","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","2","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","12","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","45","Select","Select",""],["","65862017760","CEFDINIR ","300MG","20","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","4","Select","Select",""],["","63824004124","MUCINEX","120-1200","24","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","63824004124","MUCINEX ","TAB 120-1200","24","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","-22","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","",""],["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":""}]}]}