{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIE   R NUNEZ","gend":1,"add":"310 LEE ST","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1969-03-02","age":"","mstatus":"","insh":"1080193*01","cliId":"","pno":"757\/287-5808","cno":"757\/287-5808","email":"","ename":"","eno":"","pphy":"FRISCO, SHAWNITA A MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":119880,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F34.1","E11.65","E66.01","Z71.3","Z68.42","N83.291","K42.9","R10.11","R10.13","R11.0","R85.0","K76.0","N83.8","R19.09","E11.9","Z68.41","F33.8","E55.9","F51.04","NO DATA","Z20.828","R05.","R07.0","R06.02","I10.","K21.9","Z01.818","U07.1","R09.81","R09.82","Z23.","J30.89","J45.20","Z71.89","R74.0","K85.90","E78.2","Z12.31","F32.9","M72.2","Z12.39","F41.9","K44.9","H61.23","F43.20","E11.29","E11.69","R80.9","E75.6","F43.21","E66.9"],"date":["2020-11-19","2021-01-22","2021-09-07","2020-05-20","2020-05-20","2020-09-01","2020-07-09","2020-07-15","2020-08-24","2020-07-15","2020-07-15","2020-08-24","2020-10-12","2020-10-12","2021-02-22","2020-10-12","2021-09-07","2021-06-22","2021-01-22","2021-01-22","2020-12-10","2020-12-14","2020-12-10","2021-02-23","2021-09-07","2021-02-23","2020-10-07","2020-12-14","2021-08-11","2020-12-14","2021-01-22","2021-08-11","2021-01-22","2021-01-22","2020-05-29","2020-06-04","2021-06-22","2020-09-24","2020-09-24","2021-02-22","2020-03-17","2020-04-01","2020-08-24","2021-08-11","2021-09-09","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-10-28","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","50111043302","TRAZODONE ","50MG","30","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","120","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","90","Select","Select",""],["","00781507701","LORATADINE ","10MG","90","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","75834002012","VITAMIN ","50000UNT","8","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA BL","100","Select","Select",""],["","57237000299","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","90","Select","Select",""],["","93764001154","BP ","SMALL","1","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","8","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","47781019601","OXYCOD\/APAP ","5-325MG","40","Select","Select",""],["","65862001105","SERTRALINE ","25MG","30","Select","Select",""],["","63824000832","MUCINEX ","600MG ER","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","08373982700","OPTICHAMBER ","DIA LG","1","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","57237000299","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","53885024510","ONETOUCH","ULTRA BL","100","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","93764001154","BP","SMALL","1","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","62756014202","METFORMIN","500MG ER","180","Select","Select",""],["","75834002012","VITAMIN","50000UNT","8","Select","Select",""],["","00781507701","LORATADINE","10MG","90","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","90","Select","Select",""],["","00093720198","PRAVASTATIN","20MG","90","Select","Select",""],["","47781019601","OXYCOD\/APAP","5-325MG","40","Select","Select",""],["","65862001105","SERTRALINE","25MG","30","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","08373982700","OPTICHAMBER","DIA LG","1","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","8","Select","Select",""],["","63824000832","MUCINEX","600MG ER","30","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}