{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GREGG JENKINS","gend":0,"add":"1705 RUBY CIR","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1969-03-02","age":"","mstatus":"","insh":"1916267*01","cliId":"","pno":"757\/471-2791","cno":"757\/471-2791","email":"","ename":"","eno":"","pphy":"JAVIER, FRANCIS V 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":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/685-0187","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-7938","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","H44.522","R51.","I63.9","E11.29","E11.51","H43.11","E11.3531","I10.","H35.031","Z01.818","I16.1","N17.9","K59.00","R79.89","K21.9","Z86.73","E78.2","Z91.19","E66.01","R11.0","G47.33","N39.41","Q11.1","I50.32","N18.4","E66.2","Z68.41","I13.0","E11.22","E11.65","E78.5","Z79.02","Z79.4","Z79.899","Z91.14","I12.9","E29.1","R06.02","N18.9","R80.9","H40.9","R94.31","I51.7","G81.94","E13.3599","D64.9","Q21.1","Z23.","R22.43","G47.30","E11.3522","E66.09","I50.9"],"date":["2021-11-09","2020-05-14","2020-08-16","2020-08-16","2021-11-09","2021-11-09","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2020-04-03","2020-08-18","2020-08-16","2020-08-16","2020-08-16","2020-09-09","2020-08-16","2020-08-16","2020-08-16","2021-05-24","2020-08-16","2020-08-16","2020-05-17","2020-06-29","2020-08-16","2021-11-17","2020-08-16","2020-08-16","2020-09-09","2021-11-17","2020-08-16","2020-08-16","2020-08-16","2021-11-17","2020-08-16","2020-08-16","2021-11-17","2020-01-16","2020-09-30","2021-02-15","2021-05-24","2020-05-13","2020-08-18","2020-08-18","2021-05-24","2020-09-09","2020-09-09","2020-09-09","2020-11-05","2021-06-23","2020-08-18","2020-02-24","2020-07-07","2020-09-09"],"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":[["","68645051654","AMLODIPINE ","10MG","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","24","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","00832112035","TESTOSTERONE ","1%(50MG)","150","Select","Select",""],["","68645057559","GLIPIZIDE ","10MG","60","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","9","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","00228291809","DILTIAZEM ","360MG ER","30","Select","Select",""],["","55111019605","CLOPIDOGREL ","75MG","30","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","68645049554","ATORVASTATIN ","80MG","30","Select","Select",""],["","68645019159","METOPROL ","100MG","90","Select","Select",""],["","17478021505","ATROPINE ","1% OP","5","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","15","Select","Select",""],["","62037059905","CARTIA ","240\/24HR","30","Select","Select",""],["","50111032701","HYDRALAZINE ","25MG","90","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","70069023101","BRIMONIDINE ","0.2% OP","5","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","0.1% OP","4","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","15","Select","Select",""],["","68645051354","NIFEDIPINE ","60MG ER","90","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","30","Select","Select",""],["","65862019899","GABAPENTIN ","100MG","90","Select","Select",""],["","81131038680","RELION ","31GX6MM","100","Select","Select",""],["","66887000105","TESTIM ","1%(50MG)","150","Select","Select",""],["","00228291809","DILTIAZEM","360MG ER","30","Select","Select",""],["","68645051654","AMLODIPINE","10MG","30","Select","Select",""],["","68645049554","ATORVASTATIN","80MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","24","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","00832112035","TESTOSTERONE","1%(50MG)","150","Select","Select",""],["","66887000105","TESTIM","1%(50MG)","150","Select","Select",""],["","17478021505","ATROPINE","1% OP","5","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","68645057559","GLIPIZIDE","10MG","60","Select","Select",""],["","68645019159","METOPROL","100MG","270","Select","Select",""],["","55111019605","CLOPIDOGREL","75MG","30","Select","Select",""],["","62037059905","CARTIA","240\/24HR","30","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","15","Select","Select",""],["","70069023101","BRIMONIDINE","0.2% OP","5","Select","Select",""],["","50111032701","HYDRALAZINE","25MG","90","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","15","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","67877022210","GABAPENTIN","100MG","90","Select","Select",""],["","68645051354","NIFEDIPINE","60MG ER","30","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","90","Select","Select",""],["","81131038680","RELION","31GX6MM","100","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","0.1% OP","4","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}