{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRYSTAL   N STOKES","gend":1,"add":"437 KENDALL HVN","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1985-01-29","age":"","mstatus":"","insh":"20035696*01","cliId":"","pno":"757\/758-0736","cno":"757\/758-0736","email":"","ename":"","eno":"","pphy":"WEITZMAN, DOUGLAS K 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":"757\/332-2523","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9266","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K59.09","R10.9","R39.15","H65.193","E55.9","Z11.3","E61.1","G43.709","R11.0","K21.9","F31.9","F90.2","G43.109","H69.83","R07.89","R05.","R06.02","R09.81","J20.9","Z01.419","K64.4","J30.89","B37.9","T36.95XA","M25.50","J20.8","Z20.828","G43.019","Z00.00","H66.92","H60.503","S06.0X1A","S13.9XXA","W01.0XXA","S13.4XXA","F90.9","Z88.0","Z88.5","Z88.8","R55."],"date":["2020-08-27","2021-01-15","2021-01-15","2021-04-23","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2021-07-02","2021-11-16","2020-08-27","2020-08-27","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-03","2021-04-05","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2020-02-03","2020-11-27","2020-11-27","2021-06-02","2020-08-27","2021-06-24","2021-06-24","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02"],"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":[["","55513084301","AIMOVIG ","140MG\/ML","1","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00536100901","FERROUS ","325MG","30","Select","Select",""],["","54092038701","ADDERALL ","20MG","30","Select","Select",""],["","57237003005","AMOXICILLIN ","250MG","28","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","60","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","7","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","40","Select","Select",""],["","00228306011","AMPHET\/DEXTR ","20MG ER","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","42858010401","OXYCOD\/APAP ","10-325MG","7","Select","Select",""],["","40985027288","VITAMIN ","5000UNIT","30","Select","Select",""],["","00023650110","UBRELVY ","100MG","9","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","71610012330","CETIRIZINE ","10MG","30","Select","Select",""],["","72618300002","NURTEC ","75MG ODT","8","Select","Select",""],["","52565004230","NYSTAT\/TRIAM ","","30","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","50428842972","PROBIOTIC ","","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","67877057305","BENZONATATE ","100MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","00168000615","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","59779045806","CVS ","10MG","30","Select","Select",""],["","00472016630","NYSTATIN ","100000","30","Select","Select",""],["","24208063110","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","60258015001","SF ","1.10%","51","Select","Select",""],["","55513084301","AIMOVIG","140MG\/ML","1","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00228306011","AMPHET\/DEXTR","20MG ER","30","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","40","Select","Select",""],["","54092038701","ADDERALL","20MG","30","Select","Select",""],["","57237003005","AMOXICILLIN","250MG","28","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","60258015001","SF","1.10%","51","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","42858010401","OXYCOD\/APAP","10-325MG","7","Select","Select",""],["","67877032105","IBUPROFEN","800MG","7","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","60","Select","Select",""],["","00023650110","UBRELVY","100MG","9","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","50428842972","PROBIOTIC","","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","72618300002","NURTEC","75MG ODT","8","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","52565004230","NYSTAT\/TRIAM","","30","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","59779045806","CVS","10MG","30","Select","Select",""],["","00472016630","NYSTATIN","100000","30","Select","Select",""],["","00168000615","TRIAMCINOLON","0.10%","30","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","24208063110","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","40985027288","VITAMIN","5000UNIT","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","11527073044","SOD ","PST 0.011","100","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}