{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA LINDSAY","gend":1,"add":"207 MICHIGAN DR APT G","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1959-09-29","age":"","mstatus":"","insh":"20031146*01","cliId":"","pno":"757\/768-5556","cno":"757\/768-5556","email":"","ename":"","eno":"","pphy":"GOSWAMI, BIJOYA MD","ppno":"757\/594-1803","pcpadd":"STE 140 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":119865,"pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/269-1518","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-1828","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","R03.0","N39.46","R32.","E11.36","E11.59","M79.2","E11.29","E11.69","G47.33","M47.816","I10.","R80.9","E78.5","R10.33","K59.00","E66.01","E66.9","G47.30","H40.023","H35.373","NO DATA","I87.2","M79.605","Z00.00","M54.5","M25.561","M51.36","M70.61","G89.29","M25.562","G60.9","M24.571","M24.572","M20.42","M20.41","L84.","B35.1","Z12.11","D12.0","D12.3","L72.3","R51.9","Z96.641","K59.09","M10.9","M16.11","E79.0","R94.31","R05.","R06.02","R07.0","R11.0","K63.5","K57.30","L60.0","M25.50","M79.675","M79.89","M17.11","M54.2","Z87.19","R82.90","N39.41","R06.83","Z01.810","Z11.59","M17.0","Z96.651","Z86.010","K21.9","M25.551","M25.511","Z96.619","M25.512","R60.0","Z96.1","M54.16","Z47.1"],"date":["2021-11-05","2021-11-04","2021-11-04","2021-11-04","2021-03-12","2021-05-18","2020-11-10","2021-05-27","2021-05-18","2021-05-18","2021-05-19","2021-05-18","2021-05-18","2021-05-18","2021-04-14","2021-04-14","2021-03-12","2021-04-14","2021-02-03","2021-04-23","2021-04-23","2021-09-13","2021-05-04","2021-05-04","2021-05-18","2021-07-01","2020-01-07","2021-09-13","2020-01-24","2021-09-13","2020-01-07","2021-11-05","2021-08-27","2021-08-27","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2020-07-01","2020-07-01","2020-07-01","2020-09-24","2021-03-12","2020-11-12","2020-08-05","2021-05-19","2021-07-23","2020-11-12","2020-06-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-07-01","2020-07-01","2021-08-06","2021-05-19","2020-08-12","2020-08-12","2021-08-20","2021-05-19","2020-01-06","2020-02-12","2020-01-06","2020-10-20","2020-06-29","2020-06-29","2020-09-30","2020-08-06","2020-10-20","2021-04-14","2020-01-24","2020-02-12","2020-02-12","2020-02-12","2020-04-30","2020-06-03","2021-08-17","2021-07-23"],"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":[["","68645051054","HYDROCHLOROT ","25MG","30","Select","Select",""],["","10006073035","VITAMIN ","100MCG","30","Select","Select",""],["","69784018010","POLYETH ","3350 NF","14","Select","Select",""],["","68645048054","ATORVASTATIN ","10MG","30","Select","Select",""],["","68645058259","METFORMIN ","500MG","60","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","60","Select","Select",""],["","00093075301","ATENOLOL ","100MG","30","Select","Select",""],["","11523435702","","","14","Select","Select",""],["","45802005911","NYSTATIN ","100000","30","Select","Select",""],["","00536252525","CAPSAICIN ","0.03%","60","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","30","Select","Select",""],["","64380076921","PEG-3350\/KCL ","\/SODIUM","4000","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","00006027754","JANUVIA ","100MG","30","Select","Select",""],["","50228018105","GABAPENTIN ","400MG","120","Select","Select",""],["","16714004107","ALLOPURINOL ","100MG","60","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","30","Select","Select",""],["","00143301801","COLCHICINE ","0.6MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","60793013230","FLECTOR ","1.30%","60","Select","Select",""],["","64764011907","COLCRYS ","0.6MG","30","Select","Select",""],["","53885014301","ONETOUCH ","LANCETS","100","Select","Select",""],["","51672401801","ETODOLAC ","400MG","30","Select","Select",""],["","12843003520","STOOL ","100MG","30","Select","Select",""],["","00904645780","DOK ","100MG","30","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","69680011225","CYANOCOBALAM ","1000MCG","30","Select","Select",""],["","37000035905","PRILOSEC ","20MG","90","Select","Select",""],["","00574402235","BACITRACIN ","OP","4","Select","Select",""],["","16714079904","CETIRIZINE ","10MG","45","Select","Select",""],["","49035045895","ALLERGY ","10MG","45","Select","Select",""],["","68645058259","METFORMIN","500MG","60","Select","Select",""],["","00093075301","ATENOLOL","100MG","30","Select","Select",""],["","68645051654","AMLODIPINE","10MG","30","Select","Select",""],["","16714079904","CETIRIZINE","10MG","45","Select","Select",""],["","49035045895","ALLERGY","10MG","45","Select","Select",""],["","50228018105","GABAPENTIN","400MG","120","Select","Select",""],["","68645048054","ATORVASTATIN","10MG","30","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","60","Select","Select",""],["","00006027754","JANUVIA","100MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","30","Select","Select",""],["","00536252525","CAPSAICIN","0.03%","60","Select","Select",""],["","00904113213","VITAMIN","100MCG","30","Select","Select",""],["","64380076921","PEG-3350\/KCL","\/SODIUM","4000","Select","Select",""],["","70010075401","METHOCARBAM","500MG","30","Select","Select",""],["","69784018010","POLYETH","3350 NF","14","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","12843003520","STOOL","100MG","30","Select","Select",""],["","16714004107","ALLOPURINOL","100MG","60","Select","Select",""],["","55111018015","TIZANIDINE","4MG","30","Select","Select",""],["","00904645780","DOK","100MG","30","Select","Select",""],["","64764011907","COLCRYS","0.6MG","30","Select","Select",""],["","65162071009","COLCHICINE","0.6MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","60793013230","FLECTOR","1.30%","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","37000035905","PRILOSEC","20MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","00574402235","BACITRACIN","OP","4","Select","Select",""],["","69680011225","CYANOCOBALAM","1000MCG","30","Select","Select",""],["","51672401801","ETODOLAC","400MG","30","Select","Select",""],["","45802005911","NYSTATIN","100000","30","Select","Select",""],["","49281072110","FLUBLOK ","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":[[["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":""}]}]}