{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   L JONES","gend":1,"add":"1212 31ST ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1962-08-17","age":"","mstatus":"","insh":"20030263*01","cliId":"","pno":"828\/457-2417","cno":"828\/457-2417","email":"","ename":"","eno":"","pphy":"FRISCO, SHAWNITA A MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":119880,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/597-6139","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9802","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M25.50","E79.0","R76.8","M65.312","F43.10","H92.03","H60.543","J02.9","J30.89","I10.","R07.9","J06.9","R05.","V58.89","M51.36","E87.6","M51.47","J45.40","Z88.9","J32.9","J45.41","Z00.00","Z12.39","F33.3","E78.2","F50.02","E77.8","M54.9","S60.212A","W01.0XXA","Z01.419","S32.030A","S32.050A","Z78.0","M81.0","Z32.00","R87.612","R87.810","B37.0"],"date":["2020-06-15","2021-08-31","2021-08-31","2021-08-31","2020-06-15","2021-09-20","2020-07-02","2020-07-02","2020-10-12","2020-07-02","2021-04-15","2020-07-28","2020-07-28","2020-07-28","2020-11-09","2020-11-20","2020-10-12","2020-03-25","2021-05-25","2021-05-25","2021-05-25","2020-09-01","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2020-03-25","2020-06-16","2020-06-16","2021-02-24","2020-10-20","2020-05-13","2020-05-13","2021-09-14","2021-04-14","2021-04-14","2020-05-11","2020-10-12"],"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":[["","50228018005","GABAPENTIN ","300MG","60","Select","Select",""],["","43547034106","RISPERIDONE ","1MG","60","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","57237000930","MIRTAZAPINE ","30MG","30","Select","Select",""],["","43547035410","LISINOPRIL ","20MG","30","Select","Select",""],["","51672129803","KETOCONAZOLE ","2%","60","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","59746017206","PREDNISONE ","5MG","60","Select","Select",""],["","00591352530","LIDOCAINE ","5%","10","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","60","Select","Select",""],["","16729013401","ALLOPURINOL ","100MG","60","Select","Select",""],["","65862019430","FLUOXETINE ","40MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00085461001","DULERA ","200-5MCG","13","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","20","Select","Select",""],["","16714007104","BACLOFEN ","10MG","30","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","16714063301","ALENDRONATE ","70MG","12","Select","Select",""],["","11822070538","ALLERGY ","10MG","30","Select","Select",""],["","60432053716","NYSTATIN ","100000","473","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","00597016061","SPIRIVA ","1.25MCG","4","Select","Select",""],["","00172392570","DIAZEPAM ","2MG","2","Select","Select",""],["","69238106901","POT  CHLORIDE","20MEQ ER","120","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00093598627","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","43547035410","LISINOPRIL","20MG","30","Select","Select",""],["","43547034106","RISPERIDONE","1MG","60","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","57237000930","MIRTAZAPINE","30MG","30","Select","Select",""],["","51672129803","KETOCONAZOLE","2%","60","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","59746017206","PREDNISONE","5MG","60","Select","Select",""],["","55111017915","TIZANIDINE","2MG","60","Select","Select",""],["","16729013401","ALLOPURINOL","100MG","60","Select","Select",""],["","50228018005","GABAPENTIN","300MG","60","Select","Select",""],["","65862019430","FLUOXETINE","40MG","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00591352530","LIDOCAINE","5%","10","Select","Select",""],["","65162046510","IBUPROFEN","600MG","20","Select","Select",""],["","59746021106","CYCLOBENZAPR","5MG","20","Select","Select",""],["","16714007104","BACLOFEN","10MG","30","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","16714063301","ALENDRONATE","70MG","12","Select","Select",""],["","11822070538","ALLERGY","10MG","30","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","60432053716","NYSTATIN","100000","473","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00172392570","DIAZEPAM","2MG","2","Select","Select",""],["","00597016061","SPIRIVA","1.25MCG","4","Select","Select",""],["","69238106901","POT CHLORIDE","20MEQ ER","120","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","6","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00173068220","VENTOLIN","","18","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":""}]}]}