{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERICA   L PAULHUS","gend":1,"add":"7448 FENNER ST APT 1","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1985-04-28","age":"","mstatus":"","insh":"1131042*01","cliId":"","pno":"757\/998-1749","cno":"757\/998-1749","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":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9004","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.1","R10.13","K31.89","R11.2","B37.9","M25.511","Z87.828","S39.92XA","M54.42","I10.","E11.65","R92.8","E66.01","Z68.35","M54.9","Z04.1","Z01.818","Z01.812","Z20.822","H66.92","J98.8","Z88.0","R68.89","NO DATA","L03.313","F31.9","F41.1","F90.1","K31.84","B37.3","S49.91XA","F31.12","E27.8","D35.2","Z72.0","M79.661","M25.561","M79.89","F17.210","R60.0","K13.79","I82.401","R20.2","E11.9","M79.604","N12.","B96.20","Z16.11","Z16.29","Z86.14","R39.15","R10.9"],"date":["2021-05-29","2021-07-20","2021-06-11","2021-07-20","2020-04-23","2020-11-02","2020-11-02","2021-05-04","2021-03-26","2021-10-08","2021-08-31","2020-11-04","2021-04-06","2021-04-06","2021-05-03","2021-05-03","2021-06-08","2021-06-08","2021-06-08","2020-01-18","2020-01-18","2021-10-08","2020-01-18","2021-04-06","2020-01-27","2021-08-11","2021-08-11","2021-08-11","2021-05-11","2020-04-23","2020-11-04","2021-04-06","2021-04-06","2021-04-06","2021-05-02","2021-08-31","2021-08-31","2021-08-31","2021-10-08","2021-08-31","2021-08-31","2021-08-30","2021-08-31","2021-10-08","2021-08-31","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-26"],"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":[["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","63402030230","LATUDA ","20MG","30","Select","Select",""],["","50111043302","TRAZODONE ","50MG","30","Select","Select",""],["","23155010405","METFORMIN ","1000MG","60","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","30","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","30","Select","Select",""],["","00310653004","BYDUREON ","2MG","12","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","6","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00591352530","LIDOCAINE ","5%","15","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","20","Select","Select",""],["","00713052612","PROMETHEGAN ","25MG","10","Select","Select",""],["","00093727156","PIOGLITAZONE ","15MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","12","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","20","Select","Select",""],["","65862015901","ZOLPIDEM ","5MG","30","Select","Select",""],["","00085075605","AFRIN ","0.05%","15","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","30","Select","Select",""],["","00085075605","AFRIN","0.05%","15","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","67877056310","METFORMIN","1000MG","60","Select","Select",""],["","63402030230","LATUDA","20MG","5","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","30","Select","Select",""],["","68180051703","LISINOPRIL","40MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","5","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","6","Select","Select",""],["","00310653004","BYDUREON","2MG","12","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","00591352530","LIDOCAINE","5%","15","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","20","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","00093727156","PIOGLITAZONE","15MG","90","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","70010075401","METHOCARBAM","500MG","20","Select","Select",""],["","00713052612","PROMETHEGAN","25MG","10","Select","Select",""],["","65862015901","ZOLPIDEM","5MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","12","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","3","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","6","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":""}]}]}