{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN   M JONES","gend":1,"add":"1001 24TH STREET APT 103","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1959-09-15","age":"","mstatus":"","insh":"20030179*01","cliId":"","pno":"757\/705-1499","cno":"757\/705-1499","email":"","ename":"","eno":"","pphy":"ROBLEDO, ELIZABETH MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9004","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","R05.","Z20.828","J31.0","Z72.0","M54.16","J44.9","R09.02","M54.41","M47.816","M54.2","M47.812","M79.2","M62.838","E66.9","F17.200","Z85.3","G89.29","J06.9","M54.12","I10.","E78.2","J42.","C50.919","F41.9","E78.1","F32.9","E66.3","NO DATA","M47.817","M50.30","M17.11","M85.89","Z17.0","Z79.811","Z12.11","F32.2","Z01.812","Z20.822","Z01.419","Z23.","Z12.4","R50.9","H92.01","J32.0"],"date":["2020-05-27","2021-02-09","2020-07-17","2021-06-07","2021-06-07","2021-08-25","2021-09-07","2021-09-07","2020-08-03","2021-04-22","2020-08-03","2021-04-22","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-09-29","2021-06-30","2021-04-01","2021-04-01","2021-04-01","2021-04-22","2021-04-01","2021-04-01","2021-04-01","2020-03-30","2021-04-22","2021-04-22","2020-04-03","2020-10-15","2021-04-22","2021-04-22","2021-04-22","2020-10-07","2020-09-16","2021-01-30","2021-01-30","2020-10-07","2020-10-07","2020-10-07","2020-07-17","2021-02-09","2021-02-09"],"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":[["","31722070210","LOSARTAN ","100MG","30","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","30","Select","Select",""],["","13668001001","CITALOPRAM ","20MG","30","Select","Select",""],["","16729003510","ANASTROZOLE ","1MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","67877021520","CEFUROXIME ","250MG","32","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","60","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","51672129802","KETOCONAZOLE ","2%","30","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","59746017306","PREDNISONE ","10MG","26","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","00310737220","BUDES\/FORMOT ","80-4.5","10","Select","Select",""],["","00487990425","ALBUTEROL ","1.25MG\/3","75","Select","Select",""],["","69618004610","ASPIRIN ","81MG EC","30","Select","Select",""],["","43598044674","NICOTINE ","7MG\/24HR","14","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","30","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","10","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","31722095801","BENZONATATE ","200MG","30","Select","Select",""],["","49884072703","DOXYCYC ","100MG","20","Select","Select",""],["","00135019502","NICODERM ","14MG\/24H","42","Select","Select",""],["","11822222600","","","42","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","16714007104","BACLOFEN ","10MG","60","Select","Select",""],["","69097081307","GABAPENTIN","100MG","60","Select","Select",""],["","16729003510","ANASTROZOLE","1MG","30","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","30","Select","Select",""],["","13668001001","CITALOPRAM","20MG","30","Select","Select",""],["","51672129802","KETOCONAZOLE","2%","30","Select","Select",""],["","00487990425","ALBUTEROL","1.25MG\/3","75","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","67877021520","CEFUROXIME","250MG","32","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59746017306","PREDNISONE","10MG","26","Select","Select",""],["","00310737220","BUDES\/FORMOT","80-4.5","10","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","69618004610","ASPIRIN","81MG EC","30","Select","Select",""],["","59746021106","CYCLOBENZAPR","5MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","30","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10","Select","Select",""],["","31722095801","BENZONATATE","200MG","30","Select","Select",""],["","49884072703","DOXYCYC","100MG","20","Select","Select",""],["","00135019503","NICODERM","14MG\/24H","42","Select","Select",""],["","43598044774","NICOTINE","14MG\/24H","42","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","30","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","16714007104","BACLOFEN","10MG","60","Select","Select",""],["","00378027493","TAMOXIFEN","20MG","30","Select","Select",""],["","00378027493","TAMOXIFEN ","TAB 20MG","30","Select","Select",""],["","65862052790","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","72647033104","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","58160088752","FLUARIX ","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}