{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAMELA BRADLEY","gend":1,"add":"109 RANALET DR","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1964-06-15","age":"","mstatus":"","insh":"20024276*01","cliId":"","pno":"757\/848-5113","cno":"757\/848-5113","email":"","ename":"","eno":"","pphy":"BAINES, ROBIN S MD","ppno":"757\/726-5000","pcpadd":"200 EATON ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":101284,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/325-0551","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/726-5001","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.69","J45.20","R10.32","E66.9","M25.473","K21.9","M06.4","Z71.89","H40.053","H10.13","E11.9","N95.0","N84.0","I10.","M48.07","M51.36","M16.0","Z86.010","R14.2","R15.0","R12.","E66.3","Z00.00","Z20.822","B96.81","M25.50","M17.0","M15.9","Z79.1","Z01.419","Z12.31","Z68.42","Z20.828","R05.","R06.02","R07.0","R82.90","M19.90","M75.51","Z01.812","Z23.","E11.59","E66.01","E78.5","M19.011","M75.41","I15.2"],"date":["2021-07-27","2020-11-11","2020-11-11","2021-07-27","2021-06-10","2021-05-17","2021-04-13","2021-04-13","2021-04-27","2021-04-27","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2020-07-15","2020-11-04","2020-11-04","2021-03-10","2021-03-10","2021-05-04","2021-03-10","2021-02-16","2021-03-06","2021-05-11","2021-05-04","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2020-09-04","2020-09-04","2021-07-27","2020-12-11","2020-12-11","2020-12-11","2020-12-11","2020-07-02","2020-04-16","2021-09-17","2021-05-11","2020-09-09","2021-07-27","2021-07-27","2021-07-27","2021-09-17","2021-09-17","2021-07-27"],"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":[["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","68645055554","LISINOPRIL ","40MG","30","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","75","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","60","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","59746017210","PREDNISONE ","5MG","60","Select","Select",""],["","59762500001","SULFASALAZIN ","500MG","60","Select","Select",""],["","00085113204","PROVENTIL ","HFA","20","Select","Select",""],["","64980028005","GLIPIZIDE ","5MG","90","Select","Select",""],["","16714079904","CETIRIZINE ","10MG","30","Select","Select",""],["","49035074162","ARTHRTS ","650MG","180","Select","Select",""],["","00093505998","ATORVASTATIN ","20MG","90","Select","Select",""],["","00006027754","JANUVIA ","100MG","90","Select","Select",""],["","57896020110","PAIN ","500MG","180","Select","Select",""],["","31604002585","VITAMIN ","2000UNIT","90","Select","Select",""],["","67877025145","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","6","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","14","Select","Select",""],["","62332050203","OLOPATADINE ","0.20%","5","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","64380090603","CLARITHROMYC ","500MG","28","Select","Select",""],["","43386040503","NITAZOXANIDE ","500MG","28","Select","Select",""],["","00527512170","NYSTATIN ","100000","200","Select","Select",""],["","50580078332","TYLENOL ","650MG","180","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","47781019601","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","50111033301","METRONIDAZOL ","250MG","56","Select","Select",""],["","49035045875","ALLERGY ","10MG","90","Select","Select",""],["","81131000720","D3 ","2000UNIT","90","Select","Select",""],["","43547039910","CYCLOBENZAPR ","5MG","60","Select","Select",""],["","65862053650","LEVOFLOXACIN ","250MG","14","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","30","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","55111018015","TIZANIDINE","4MG","60","Select","Select",""],["","59746017210","PREDNISONE","5MG","60","Select","Select",""],["","63481068447","VOLTAREN","1%","100","Select","Select",""],["","00085113204","PROVENTIL","HFA","20","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","68645055554","LISINOPRIL","40MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","16714079904","CETIRIZINE","10MG","30","Select","Select",""],["","00487950125","ALBUTEROL","0.08%","75","Select","Select",""],["","53885027025","ONETOUCH","VERIO","100","Select","Select",""],["","00006027754","JANUVIA","100MG","90","Select","Select",""],["","64980028005","GLIPIZIDE","5MG","90","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","59762500001","SULFASALAZIN","500MG","60","Select","Select",""],["","31604002585","VITAMIN","2000UNIT","90","Select","Select",""],["","65162047810","NITROFURANTN","100MG","6","Select","Select",""],["","00093505998","ATORVASTATIN","20MG","90","Select","Select",""],["","62332050203","OLOPATADINE","0.20%","5","Select","Select",""],["","49035074162","ARTHRTS","650MG","180","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","57896020110","PAIN","500MG","180","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","47781019601","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","50580078332","TYLENOL","650MG","180","Select","Select",""],["","81131000720","D3","2000UNIT","90","Select","Select",""],["","49035045875","ALLERGY","10MG","90","Select","Select",""],["","67877025145","TRIAMCINOLON","0.10%","454","Select","Select",""],["","50111033301","METRONIDAZOL","250MG","56","Select","Select",""],["","64380090603","CLARITHROMYC","500MG","28","Select","Select",""],["","00527512170","NYSTATIN","100000","200","Select","Select",""],["","42806031205","DOXYCYCL","100MG","14","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","20","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","65862053650","LEVOFLOXACIN","250MG","14","Select","Select",""],["","43386040503","NITAZOXANIDE","500MG","28","Select","Select",""],["","43547039910","CYCLOBENZAPR","5MG","60","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","20","Select","Select",""],["","49035080283","8HR ","TAB 650MG ER","180","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":""}]}]}