{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAYMOND   R HARGRAVE","gend":0,"add":"12276 GREAT SPRINGS ROAD","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1959-11-25","age":"","mstatus":"","insh":"20028618*01","cliId":"","pno":"757\/642-1925","cno":"757\/642-1925","email":"","ename":"","eno":"","pphy":"LOPRESTI, BARTHOLOMEW M MD","ppno":"757\/542-2000","pcpadd":"STE 200 20209 SENTARA WAY","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":139535,"pcpname":"SMG - Sentara Family Medicine Physicians - St. Luke's","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","R05.","J12.89","K76.6","R13.10","K64.9","R12.","M25.562","Z68.34","M79.604","Z68.35","E11.65","Z79.4","M23.8X2","Z96.652","M65.9","S60.221A","S50.11XA","Z23.","K04.7","K70.30","R18.8","B18.2","I85.00","K72.90","Z86.010","K92.1","E66.9","Z00.00","Z13.89","D69.6","R94.5","R22.2","R20.2","M25.362","M54.5","G89.29","I10.","NO DATA","M79.671","R22.31","G47.00","M54.2","M25.511","E66.01","E11.40","M77.41","M24.572","M24.571","M20.12","M20.11","L60.3","R93.2","R53.81","K70.31","R10.84","T84.318A","M23.52","M54.16","R23.8","Z68.36","E11.9","R10.9"],"date":["2020-09-11","2020-09-11","2020-09-11","2020-10-29","2020-10-29","2020-10-29","2021-01-18","2021-10-26","2021-01-18","2021-03-09","2021-06-18","2021-07-30","2021-07-30","2020-02-06","2021-09-24","2020-02-06","2020-05-08","2020-05-08","2021-03-17","2020-07-17","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2020-08-31","2021-09-22","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-02-05","2021-09-24","2021-10-26","2020-01-27","2020-01-27","2021-07-30","2021-06-18","2021-06-18","2021-06-22","2021-06-22","2020-03-05","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-09-22","2021-09-22","2021-10-26","2021-10-26","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-10-26","2021-10-26"],"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":[["","69315011710","FUROSEMIDE ","40MG","30","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","69097086807","NADOLOL ","40MG","90","Select","Select",""],["","16729022601","SPIRONOLACT ","50MG","60","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","4","Select","Select",""],["","08560940002","V-GO ","","30","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","300","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","00781185220","AMOX\/K ","875-125","14","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","59762219803","AZITHROMYCIN ","250MG","6","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","10","Select","Select",""],["","00002773701","INSULIN ","100\/ML","30","Select","Select",""],["","08627005303","DEXCOM ","SENSOR","9","Select","Select",""],["","13668000701","ZOLPIDEM ","5MG","30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","30","Select","Select",""],["","69097086807","NADOLOL","40MG","30","Select","Select",""],["","16729022601","SPIRONOLACT","50MG","60","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","30","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","08560940002","V-GO","","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","53885027210","ONETOUCH","VERIO","300","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","00781185220","AMOX\/K","875-125","14","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","4","Select","Select",""],["","64380080707","IBUPROFEN","800MG","10","Select","Select",""],["","59762219803","AZITHROMYCIN","250MG","6","Select","Select",""],["","00002773701","INSULIN","100\/ML","30","Select","Select",""],["","08627005303","DEXCOM","SENSOR","9","Select","Select",""],["","13668000701","ZOLPIDEM","5MG","30","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","52817033110","CYCLOBENZAPR","7.5MG","30","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","69097094312","GABAPENTIN","300MG","28","Select","Select",""],["","52817033110","CYCLOBENZAPR ","TAB 7.5MG","25","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","28","Select","Select",""],["","59762444002","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","55111064505","OMEPRAZOLE ","CAP 40MG","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","",""],["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":""}]}]}