{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA WILMER","gend":1,"add":"512 ASHLAWN DR APT 2","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1989-04-21","age":"","mstatus":"","insh":"1836070*01","cliId":"","pno":"757\/785-7147","cno":"757\/785-7147","email":"","ename":"","eno":"","pphy":"MPOY KANYINDA, JEAN MARIE K MD","ppno":"757\/388-9925","pcpadd":"7401 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/965-8519","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O28.3","O10.913","Z3A.34","K21.9","O99.89","R51.","Z3A.11","O24.112","O16.2","B00.9","Z3A.14","O35.9XX0","Z3A.23","V23.9","O24.119","Z71.3","Z01.89","Z3A.35","E11.29","E78.2","V58.89","R80.9","Z68.42","O24.111","O16.1","Z3A.12","Z3A.26","R82.90","O24.913","Z3A.37","O10.02","O98.52","Z3A.38","Z37.0","Z20.828","O34.211","O24.424","O99.52","J45.909","O99.62","O99.214","Z79.4","Z79.899","Z79.82","Z01.419","E11.9","Z32.01","Z3A.08","Z3A.18","Z04.3","O16.3","Z3A.30","O34.219","G89.18","I10.","G50.1","O99.211","R89.9","O99.213","E66.01","O24.113","Z3A.36","O75.82","Z11.52","R50.9","Z20.822"],"date":["2020-11-07","2020-11-25","2020-11-07","2020-12-04","2020-05-28","2020-05-28","2020-05-28","2020-09-08","2020-08-24","2020-12-04","2020-06-16","2020-08-24","2020-08-24","2020-11-19","2020-12-02","2020-12-02","2020-08-24","2020-11-13","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-06-04","2020-06-04","2020-06-04","2020-09-08","2020-09-08","2020-12-02","2020-11-25","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-03-13","2020-12-16","2020-04-24","2020-05-11","2020-07-14","2020-10-12","2020-11-19","2020-10-12","2020-10-12","2020-12-05","2020-12-16","2020-04-08","2020-05-05","2020-05-05","2020-11-06","2020-11-06","2020-11-19","2020-11-19","2020-12-04","2021-09-13","2021-09-02","2021-09-02"],"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":[["","00713028031","BACITRACIN ","500\/GM","28","Select","Select",""],["","68645055354","LISINOPRIL ","20MG","30","Select","Select",""],["","55111015834","OMEPRAZOLE ","20MG","30","Select","Select",""],["","68645057390","GLIMEPIRIDE ","4MG","60","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","600MG","20","Select","Select",""],["","00591060601","LABETALOL ","200MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","14","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","90","Select","Select",""],["","68645048154","ATORVASTATIN ","20MG","30","Select","Select",""],["","66733082259","INSULIN ","100\/ML","15","Select","Select",""],["","00002803101","GLUCAGON ","1MG","1","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","15","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","2","Select","Select",""],["","50580049660","TYLENOL ","325MG","20","Select","Select",""],["","49035056314","ASPIRIN ","81MG EC","60","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","21","Select","Select",""],["","16714069803","VALACYCLOVIR ","500MG","12","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","1","Select","Select",""],["","59746017310","PREDNISONE ","10MG","15","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","49035065082","EQ ","20MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","49035052614","","","60","Select","Select",""],["","00310653004","BYDUREON ","2MG","4","Select","Select",""],["","65862078430","ESOMEPRA ","40MG DR","30","Select","Select",""],["","68645055354","LISINOPRIL","20MG","30","Select","Select",""],["","55111015834","OMEPRAZOLE","20MG","30","Select","Select",""],["","68645057390","GLIMEPIRIDE","4MG","60","Select","Select",""],["","68645056259","IBUPROFEN","600MG","20","Select","Select",""],["","45802006070","BACITRACIN","500\/GM","144","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","50580049660","TYLENOL","325MG","20","Select","Select",""],["","68645048154","ATORVASTATIN","20MG","30","Select","Select",""],["","16714069803","VALACYCLOVIR","500MG","12","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","2","Select","Select",""],["","59746017310","PREDNISONE","10MG","15","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","9","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","200","Select","Select",""],["","00591060601","LABETALOL","200MG","60","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","14","Select","Select",""],["","53885065701","ONETOUCH","VERIO","1","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","66733082259","INSULIN","100\/ML","15","Select","Select",""],["","00002803101","GLUCAGON","1MG","1","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","49035056314","ASPIRIN","81MG EC","60","Select","Select",""],["","49035065082","EQ","20MG","30","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00310653004","BYDUREON","2MG","4","Select","Select",""],["","65862078430","ESOMEPRA","40MG DR","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","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":""}]}]}