{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY   L SANDRIDGE","gend":1,"add":"1052 OLD FURNACE RD APT A","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1966-08-24","age":"","mstatus":"","insh":"20034494*01","cliId":"","pno":"540\/271-4556","cno":"540\/271-4556","email":"","ename":"","eno":"","pphy":"MORGAN, ALAN J MD","ppno":"540\/564-7300","pcpadd":"1661 S MAIN ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7100","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E11.65","F41.1","F32.1","F41.9","M25.561","F45.42","G89.29","M79.7","M54.5","M54.16","M41.84","Z68.42","Z79.899","M13.861","M13.862","R25.2","B02.23","M17.11","E66.01","M76.61","NO DATA","E03.9","E78.5","F32.9","Z96.653","J44.9","I25.810","N17.9","Z47.1","M17.12","E11.22","I13.0","I50.9","E11.42","M41.34","M51.37","G47.33","I47.1","I34.0","I48.91","I25.10","M54.6","R32.","R52.","R60.9","M25.571","W19.XXXA","M67.01","M77.31","M65.9","E11.9","M25.511","E66.9","F11.20","Z13.89","N39.41","K21.9","B37.2","Z13.29","S97.81XA","R22.41","M54.2","M50.30","M47.814","M51.34","M51.36","E11.40","M17.0","Z51.81","B02.29","Z71.3","N19.","M25.569","M54.9","S99.921A","E55.9","M25.562","N90.89","M22.41","M71.21","I49.9","N17.0","M77.11","K59.00","M79.89","M79.661","Z91.81","S80.211A","S83.91XA","Z01.810","Z98.890","S80.01XA","Z96.651"],"date":["2021-04-15","2021-04-15","2020-02-04","2020-02-28","2021-03-22","2021-08-12","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2020-09-24","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-03-18","2020-12-28","2021-03-09","2021-03-29","2021-03-02","2021-04-15","2021-01-19","2021-03-18","2021-03-22","2021-03-18","2021-03-19","2021-03-22","2021-10-12","2021-03-22","2021-03-22","2021-04-15","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-08-30","2021-09-04","2020-06-17","2020-06-17","2021-03-09","2020-06-17","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2020-02-17","2020-11-12","2021-08-17","2020-12-03","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2020-06-18","2021-04-19","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-06-17","2020-10-14","2021-08-12","2020-05-05","2020-11-18","2020-11-18","2021-03-16","2021-03-18","2021-03-29","2021-03-29","2021-04-19","2021-04-19","2020-04-14","2020-09-12","2020-09-12","2021-03-02","2021-03-02","2021-08-12","2021-10-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"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":[["","51672128902","NYSTATIN ","100000","30","Select","Select",""],["","69557011130","ZTLIDO ","1.80%","7","Select","Select",""],["","00832105410","BACLOFEN ","10MG","120","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","20-25MG","30","Select","Select",""],["","68682010810","NIFEDIPINE ","30MG ER","30","Select","Select",""],["","51672127406","BETAMETH ","0.05%","45","Select","Select",""],["","00603497528","OXYBUTYNIN ","5MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","53885099425","ONETOUCH ","ULTRA BL","25","Select","Select",""],["","49884093547","DICLOFENAC ","1%","400","Select","Select",""],["","68382075810","METFORMIN ","500MG","60","Select","Select",""],["","10702001801","OXYCODONE ","5MG","120","Select","Select",""],["","00378912198","FENTANYL ","25MCG\/HR","10","Select","Select",""],["","68180059206","DESVENLAFAX ","50MG ER","30","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","180","Select","Select",""],["","57664047758","METOPROL ","50MG","30","Select","Select",""],["","00071102701","LYRICA ","165MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","DIPROP","30","Select","Select",""],["","50428054089","CVS ","5000UNIT","90","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","10","Select","Select",""],["","00406831501","MORPHINE ","15MG ER","30","Select","Select",""],["","63481068447","VOLTAREN ","1%","600","Select","Select",""],["","45802048678","DOCUSATE ","100MG","120","Select","Select",""],["","00310621030","FARXIGA ","10MG","90","Select","Select",""],["","53746054201","POT  CHLORIDE","10MEQ ER","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","00006494300","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","50428488021","STOOL ","100MG","120","Select","Select",""],["","00005197102","PREVNAR ","","0","Select","Select",""],["","50458058030","XARELTO ","10MG","27","Select","Select",""],["","43598029290","PREGABALIN ","50MG","90","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","5","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","90","Select","Select",""],["","64764075030","TRINTELLIX ","20MG","30","Select","Select",""],["","53885099425","ONETOUCH","ULTRA BL","25","Select","Select",""],["","51672127406","BETAMETH","0.05%","45","Select","Select",""],["","00603497528","OXYBUTYNIN","5MG","30","Select","Select",""],["","51672128902","NYSTATIN","100000","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","10702001801","OXYCODONE","5MG","120","Select","Select",""],["","64764075030","TRINTELLIX","20MG","30","Select","Select",""],["","49884093547","DICLOFENAC","1%","400","Select","Select",""],["","69557011130","ZTLIDO","1.80%","7","Select","Select",""],["","00071102701","LYRICA","165MG","30","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","68180052001","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","57664047758","METOPROL","50MG","30","Select","Select",""],["","00378912198","FENTANYL","25MCG\/HR","10","Select","Select",""],["","00832105410","BACLOFEN","10MG","120","Select","Select",""],["","68382075810","METFORMIN","500MG","60","Select","Select",""],["","16729020001","BUSPIRONE","5MG","60","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","68682010810","NIFEDIPINE","30MG ER","30","Select","Select",""],["","68180059206","DESVENLAFAX","50MG ER","30","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","10","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","30","Select","Select",""],["","63481068447","VOLTAREN","1%","600","Select","Select",""],["","45802048678","DOCUSATE","100MG","120","Select","Select",""],["","50428054089","CVS","5000UNIT","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00006494300","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","00310620530","FARXIGA","5MG","30","Select","Select",""],["","50428488021","STOOL","100MG","120","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","43598029290","PREGABALIN","50MG","90","Select","Select",""],["","00406831501","MORPHINE","15MG ER","30","Select","Select",""],["","65862018730","ONDANSETRON","4MG","5","Select","Select",""],["","50458058030","XARELTO","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","90","Select","Select",""],["","53746054201","POT CHLORIDE","10MEQ ER","90","Select","Select",""],["","50428047857","EYE ","DRO 0.025%OP","5","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","60","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":""}]}]}