{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL   E MCADAMS","gend":1,"add":"5517 SANDPIPER LN","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1958-05-09","age":"","mstatus":"","insh":"1366050*01","cliId":"","pno":"757\/233-7055","cno":"757\/233-7055","email":"","ename":"","eno":"","pphy":"BELARDO, BETYSHIA J MD","ppno":"757\/413-7600","pcpadd":"STE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":450016,"pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-7601","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M46.1","G43.009","NO DATA","G43.709","G44.219","M47.816","M54.16","M54.5","M54.12","M54.2","M47.817","Z79.899","M53.3","M47.896","Z01.419","Z23.","R11.0","Z12.31","E55.9","Z12.4","R60.0","Z13.29","R68.89","D50.9","R60.9","L23.9","J30.1","R63.0","L81.9","Z13.1","N28.1","G89.4"],"date":["2020-09-08","2021-05-25","2021-11-22","2020-11-16","2021-05-25","2021-11-22","2021-11-22","2021-09-01","2020-04-01","2020-04-01","2021-11-22","2021-11-22","2020-05-15","2021-06-15","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-03-19","2021-03-19"],"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":[["","00832105515","BACLOFEN","20MG","90","Select","Select",""],["","65862052305","GABAPENTIN","600MG","90","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","30","Select","Select",""],["","49884028901","MEGESTROL","20MG","30","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","69097012403","TOPIRAMATE","100MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","23155005519","NARATRIPTAN","2.5MG","12","Select","Select",""],["","00603498221","OXYCOD\/APAP","10-325MG","90","Select","Select",""],["","63481062970","PERCOCET","10-325MG","90","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","60","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","10702001150","HYDROXYZ","25MG","120","Select","Select",""],["","99207029002","ESOTERICA","2% FADE","70","Select","Select",""],["","45802006435","TRIAMCINOLON","0.10%","45","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","90","Select","Select",""],["","00904759180","FEROSUL","325MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","60951071270","ENDOCET","10-325MG","90","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00832105515","BACLOFEN ","TAB 20MG","90","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","49884028901","MEGESTROL ","TAB 20MG","30","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","63481062970","PERCOCET ","TAB 10-325MG","90","Select","Select",""],["","23155005519","NARATRIPTAN ","TAB 2.5MG","12","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","69097012403","TOPIRAMATE ","TAB 100MG","30","Select","Select",""],["","00603498221","OXYCOD\/APAP ","TAB 10-325MG","90","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","60951071270","ENDOCET ","TAB 10-325MG","90","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","60","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","45","Select","Select",""],["","60505083001","MOMETASONE ","SPR 50MCG","17","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","99207029002","ESOTERICA ","CRE 2% FADE","70","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","90","Select","Select",""],["","00904759180","FEROSUL ","TAB 325MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}