{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAUREL   R BURLEY","gend":1,"add":"1736 INDEPENDENCE BLVD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1968-04-23","age":"","mstatus":"","insh":"1738207*01","cliId":"","pno":"757\/738-3575","cno":"757\/738-3575","email":"","ename":"","eno":"","pphy":"ANDERSON, ROBIN N MD","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9772","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M79.7","M19.90","I10.","R79.89","E78.2","R31.1","M62.830","R53.83","M47.816","K42.9","D49.0","Z12.11","D12.3","K59.00","K64.8","M25.50","J45.20","M41.80","G89.29","G89.4","M54.16","K42.0","R93.5","E55.9","Z01.411","R10.32","N95.2","R11.0","M54.6","R10.9","F95.9","F41.1","F33.1","Z01.818","Z11.59","R19.8","D50.8","R10.33","F90.0","N10.","Z71.89","K63.5","K21.9"],"date":["2021-06-30","2020-09-17","2020-09-17","2021-08-31","2020-10-19","2021-06-04","2020-10-27","2021-01-29","2021-01-29","2021-09-08","2020-05-28","2020-06-26","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-09-22","2021-08-31","2021-06-30","2021-06-30","2021-08-03","2021-08-03","2020-05-28","2020-06-30","2021-08-31","2020-08-24","2020-11-06","2020-08-24","2020-11-06","2021-02-22","2021-02-22","2021-06-04","2020-03-11","2020-03-11","2020-07-28","2020-07-28","2021-02-16","2021-04-05","2020-01-08","2020-04-07","2020-06-20","2020-06-20","2020-07-30","2021-08-31"],"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":[["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","69097083512","SERTRALINE ","100MG","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","20MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","6","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","51991074790","DULOXETINE ","30MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","10702001801","OXYCODONE ","5MG","10","Select","Select",""],["","43598029390","PREGABALIN ","75MG","60","Select","Select",""],["","00085113201","PROVENTIL ","HFA","7","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","46581083006","SALONPAS ","4%","10","Select","Select",""],["","00378932132","WIXELA ","250\/50","180","Select","Select",""],["","31722056560","INDOMETHACIN ","75MG ER","60","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","31722059690","FENOFIBRATE ","145MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","60","Select","Select",""],["","00173069600","ADVAIR ","250\/50","180","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","180","Select","Select",""],["","16714065202","CIPROFLOXACN ","500MG","20","Select","Select",""],["","75826011410","PHENAZOPYRID ","100MG","6","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","60","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","30","Select","Select",""],["","59746017306","PREDNISONE ","10MG","26","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","30","Select","Select",""],["","57664037708","TRAMADOL ","50MG","14","Select","Select",""],["","11822318000","ACETAMIN ","500MG","60","Select","Select",""],["","57896020401","ACETAMINOPHE ","500MG","60","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","20","Select","Select",""],["","65862090801","CELECOXIB ","100MG","30","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","24658031205","DOXYCYCL","100MG","10","Select","Select",""],["","69097083512","SERTRALINE","100MG","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","90","Select","Select",""],["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","51991074790","DULOXETINE","30MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","10702001801","OXYCODONE","5MG","10","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","6","Select","Select",""],["","00378932132","WIXELA","250\/50","180","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","16714065202","CIPROFLOXACN","500MG","20","Select","Select",""],["","43598029390","PREGABALIN","75MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","00085113201","PROVENTIL","HFA","7","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59746017306","PREDNISONE","10MG","26","Select","Select",""],["","46581083006","SALONPAS","4%","10","Select","Select",""],["","70010075401","METHOCARBAM","500MG","30","Select","Select",""],["","31722056560","INDOMETHACIN","75MG ER","60","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","31722059690","FENOFIBRATE","145MG","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","11822318000","ACETAMIN","500MG","60","Select","Select",""],["","57896020401","ACETAMINOPHE","500MG","60","Select","Select",""],["","57664037708","TRAMADOL","50MG","60","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","60","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","180","Select","Select",""],["","65862090801","CELECOXIB","100MG","30","Select","Select",""],["","75826011410","PHENAZOPYRID","100MG","6","Select","Select",""],["","65862044830","VALACYCLOVIR ","TAB 500MG","40","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","CRE DIPROP","45","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","",""],["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":""}]}]}