{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GRADY   C CARMACK","gend":0,"add":"205 FRANKLIN AVE APT A","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1979-06-17","age":"","mstatus":"","insh":"20025005*01","cliId":"","pno":"757\/673-7468","cno":"757\/673-7468","email":"","ename":"","eno":"","pphy":"GOODMAN, BENJAMIN MD","ppno":"757\/446-8920","pcpadd":"825 FAIRFAX AVE SUITE 445","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100073,"pcpname":"SMG - Sentara Hospital Medicine Physicians - SNGH","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/319-5540","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5242","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","R05.","R09.82","L30.9","F41.9","F17.200","Z76.0","Z21.","Z79.899","R21.","F33.2","K21.9","B20.","E55.9","Z11.3","F32.9","Z68.20","F12.20","F14.20","F10.239","M77.41","L85.1","L85.3","M79.674","S59.902A","F14.23","M77.42","M79.672","R00.2","Z13.220","Z11.59","G62.9","R13.12","M79.673","L02.416","F17.210","J45.909","R53.83","M47.816","Z23.","T50.905A","Z00.00","Z87.09","J06.9","F10.24","F14.24","F81.9","I10.","F11.23"],"date":["2020-07-26","2020-02-01","2020-02-01","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-07-29","2020-11-10","2021-01-11","2020-09-09","2020-09-09","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2020-05-27","2020-04-08","2020-05-27","2020-04-08","2020-09-14","2020-11-11","2020-05-27","2020-05-27","2021-06-18","2021-01-11","2021-01-11","2020-07-22","2020-07-22","2020-07-22","2020-09-14","2020-11-09","2020-11-10","2020-11-10","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09"],"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":[["","59676057530","PREZCOBIX ","800-150","30","Select","Select",""],["","50268086615","VITAMIN ","5000UNIT","4","Select","Select",""],["","72205001190","PREGABALIN ","25MG","60","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","30","Select","Select",""],["","61958250101","BIKTARVY ","","30","Select","Select",""],["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","62332000131","FAMOTIDINE ","20MG","60","Select","Select",""],["","70710122501","AMITRIPTYLIN ","10MG","60","Select","Select",""],["","51672130104","AMMONIUM ","12%","280","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","00378230201","PRAZOSIN ","2MG","14","Select","Select",""],["","10135014901","DIPHENHYDRAM ","25MG","16","Select","Select",""],["","68682011001","PIMECROLIMUS ","1%","30","Select","Select",""],["","00168014630","HYDROCORT ","2.50%","28","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","68462056417","MUPIROCIN ","2%","15","Select","Select",""],["","60505265401","TRAZODONE ","100MG","28","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","40","Select","Select",""],["","65862078430","ESOMEPRA ","40MG DR","14","Select","Select",""],["","59148003813","REXULTI ","2MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","40","Select","Select",""],["","43547028810","BUPROPION ","100MG SR","28","Select","Select",""],["","00054001925","PREDNISONE ","50MG","5","Select","Select",""],["","00904530660","BANOPHEN ","25MG","16","Select","Select",""],["","00187510001","ELIDEL ","1%","30","Select","Select",""],["","00067628171","MAALOX ","ADVANCED","355","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","72205001190","PREGABALIN","25MG","60","Select","Select",""],["","53191036201","VITAMIN","50000UNT","4","Select","Select",""],["","59676057530","PREZCOBIX","800-150","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","51672130104","AMMONIUM","12%","280","Select","Select",""],["","68645056354","IBUPROFEN","800MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","62332000131","FAMOTIDINE","20MG","60","Select","Select",""],["","70710122501","AMITRIPTYLIN","10MG","60","Select","Select",""],["","68462056417","MUPIROCIN","2%","15","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","40","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","40","Select","Select",""],["","00378230201","PRAZOSIN","2MG","14","Select","Select",""],["","59148003813","REXULTI","2MG","14","Select","Select",""],["","65862078430","ESOMEPRA","40MG DR","14","Select","Select",""],["","60505265401","TRAZODONE","100MG","28","Select","Select",""],["","43547028810","BUPROPION","100MG SR","28","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","68462060935","PIMECROLIMUS","1%","30","Select","Select",""],["","10135014901","DIPHENHYDRAM","25MG","16","Select","Select",""],["","00168014630","HYDROCORT","2.50%","28","Select","Select",""],["","00904530660","BANOPHEN","25MG","16","Select","Select",""],["","00187510001","ELIDEL","1%","30","Select","Select",""],["","00067628171","MAALOX","ADVANCED","355","Select","Select",""],["","59310057922","PROAIR","","17","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","",""],["No","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":""}]}]}