{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON   L TAYLOR","gend":1,"add":"1767 PARRISH ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1961-01-26","age":"","mstatus":"","insh":"20036032*01","cliId":"","pno":"757\/309-3127","cno":"757\/309-3127","email":"","ename":"","eno":"","pphy":"ESPIRITU, KEITH MD","ppno":"757\/983-1777","pcpadd":"213 RIVER WALK PKWY STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":700507,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Riverwalk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/785-7801","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9043","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","Z96.651","Z96.652","T84.032A","Z13.828","T84.53XA","T84.59XA","G89.18","NO DATA","F41.9","D50.8","M79.89","J45.30","Z01.810","Z01.812","Z96.659","R00.0","R94.31","Z01.818","Z12.39","Z00.00","F31.77","G25.81","F41.1","K21.9","E78.00","G47.01","M25.561","G44.229","L29.9","J30.9","V58.89","M25.661","J45.20","D62.","E66.01","M25.569","S49.90XA","I82.622","M19.90","J45.909","D64.9","S10.93XA","S40.012A","S40.011A","S80.01XA","R09.81","M25.512","M19.012","J31.0","J02.9","Z68.42","J45.40","Z88.8","F79.","Z87.891","F31.9","Z79.51","Z79.899","Z90.711","M19.072","M79.605","I10.","Z45.2","T82.524A","M25.562","G89.29","H52.13","G47.00","H92.09","R35.1","L85.3","Z12.31","R05.1","R35.0"],"date":["2020-07-14","2021-09-14","2021-05-07","2020-12-29","2020-12-29","2021-08-10","2021-08-17","2021-05-07","2021-05-14","2021-05-14","2021-05-14","2021-06-02","2021-08-12","2021-04-19","2021-05-05","2021-05-12","2021-04-19","2021-04-19","2021-04-29","2021-04-29","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2020-07-14","2021-07-06","2021-08-12","2021-08-12","2021-08-12","2021-07-06","2021-04-22","2021-05-12","2021-05-12","2021-06-15","2021-06-01","2021-06-01","2021-07-06","2021-06-06","2021-07-06","2021-07-06","2021-03-02","2021-03-02","2021-03-02","2021-06-02","2020-03-17","2020-02-07","2020-02-07","2020-03-17","2020-03-17","2021-05-07","2021-08-12","2021-05-07","2021-07-06","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2020-01-15","2020-01-15","2020-02-07","2021-05-10","2021-05-10","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-06-15","2021-06-15","2021-08-12","2021-11-10","2021-11-10"],"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":[["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00093321205","CLONAZEPAM ","1MG","30","Select","Select",""],["","67877057305","BENZONATATE ","100MG","30","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","300","Select","Select",""],["","43598056601","FLUOXETINE ","20MG","30","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","00603254021","BUTAL\/APAP ","50-325MG","30","Select","Select",""],["","70377000215","SIMVASTATIN ","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00085720601","DULERA ","100-5MCG","13","Select","Select",""],["","65162089129","MOMETASONE ","50MCG","17","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","2.5-2.5%","30","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","43386005019","GAVILYTE-N ","FLAV PK","4000","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","60505384901","CELECOXIB ","200MG","30","Select","Select",""],["","10702001801","OXYCODONE ","5MG","42","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON ","0.10%","60","Select","Select",""],["","57896063506","SLOW ","70-117MG","90","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","45802041926","AMMONIUM ","12%","400","Select","Select",""],["","68585000575","MAG64 ","64MG","90","Select","Select",""],["","00904052380","VITAMIN ","500MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","50428047796","SKIN ","12%","400","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","30","Select","Select",""],["","40985027112","B-12 ","2500MCG","30","Select","Select",""],["","00603020922","MAG ","400MG","30","Select","Select",""],["","57896020110","PAIN ","500MG","60","Select","Select",""],["","69618004410","DOCUSATE ","100MG","30","Select","Select",""],["","70677005801","SM ","8.6MG","60","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","30","Select","Select",""],["","76282057090","PREGABALIN ","75MG","20","Select","Select",""],["","00003376474","ELIQUIS ","5MG","74","Select","Select",""],["","69618006610","ASPIRIN ","81MG EC","84","Select","Select",""],["","13668047330","FLUOXETINE","20MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","1MG","30","Select","Select",""],["","70377000215","SIMVASTATIN","10MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","300","Select","Select",""],["","00603254021","BUTAL\/APAP","50-325MG","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN","2.5-2.5%","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","00085720601","DULERA","100-5MCG","13","Select","Select",""],["","65162089129","MOMETASONE","50MCG","17","Select","Select",""],["","60505384901","CELECOXIB","200MG","30","Select","Select",""],["","68585000575","MAG64","64MG","90","Select","Select",""],["","57896063506","SLOW","70-117MG","90","Select","Select",""],["","65162019050","NAPROXEN","500MG","60","Select","Select",""],["","67877025130","TRIAMCINOLON","0.10%","60","Select","Select",""],["","45802041926","AMMONIUM","12%","400","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","42858000101","OXYCODONE","5MG","42","Select","Select",""],["","57896020110","PAIN","500MG","60","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","70677005801","SM","8.6MG","60","Select","Select",""],["","76282057090","PREGABALIN","75MG","20","Select","Select",""],["","00003376474","ELIQUIS","5MG","74","Select","Select",""],["","69618004410","DOCUSATE","100MG","30","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","30","Select","Select",""],["","00904052380","VITAMIN","500MG","100","Select","Select",""],["","40985027112","B-12","2500MCG","30","Select","Select",""],["","50428047796","SKIN","12%","400","Select","Select",""],["","69618006610","ASPIRIN","81MG EC","84","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","43386005019","GAVILYTE-N","FLAV PK","4000","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00603020922","MAG","400MG","30","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","42192080201","PHENAZOPYRID ","TAB 200MG","9","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":""}]}]}