{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYMONA THORNE","gend":1,"add":"136 DOOLITTLE RD APT # 18","city":"HAMPTON","state":"VA","zip":23666,"dob":"1961-02-22","age":"","mstatus":"","insh":"20036244*01","cliId":"","pno":"757-593-2052","cno":"757-593-2052","email":"","ename":"","eno":"","pphy":"GLAVE, KRISTLE M NP","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":149598,"pcpname":"SMG - Sentara Family Medicine Physicians - Peninsula Towne","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/827-9978","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42.","S20.169A","L29.9","J45.20","M86.659","M54.5","G62.9","G89.21","Z12.39","W57.XXXA","G89.29","M00.062","B95.7","Z96.652","B37.3","G89.4","M16.10","Z79.891","M17.0","F17.200","M25.562","M25.572","R79.89","R07.9","I10.","G44.52","I26.99","F32.0","R43.2","J45.40","J41.1","M72.2","S76.192A","M54.16","M79.604","M79.605","I44.1","R00.0","R00.2","V58.89","Z47.89","M54.17","Z04.9","R68.84","E66.09","F17.209","R06.02","R55.","S40.012A","S70.02XA","S70.12XA","J98.4","R06.00","M79.671","Z91.81","M54.41","M25.561","Z86.718","R25.2","E55.9","Z47.1","Z09.","H73.91","NO DATA","T84.84XA","R06.81","M51.36","H90.3","H60.8X3","H93.13","E66.9","I82.441","R91.1","Z87.891","Z68.37","R26.9","R05.","I51.7","H25.813","I49.1","I49.3","I47.1","S79.922A","M62.152","L20.81","L21.8","R51.","D16.4","Z20.828","D75.1","I82.401","J84.178","R92.1","R91.8","I82.431","L20.84","L71.0","E78.00","R73.01","J30.1","I82.409","R11.2","D32.9","H81.12","E66.01","N30.01","N39.0","E11.9","F17.210","J44.9","B96.20","M19.90","Z88.8","Z88.6","Z91.041","Z80.3","S76.112S","S16.1XXA","G44.209","X50.1XXA","N76.0","K21.9","R07.89","R20.2","H93.293","H61.21","Z98.890","M47.816","T84.54XD","M25.571","Z96.7","R51.9","B34.9","K08.89","Z87.898","Z79.01","R22.0","M66.852","M25.362","M17.11","E11.59","Z23.","E11.69","I15.2","E78.5","M62.838"],"date":["2020-10-26","2020-05-26","2020-05-26","2020-05-26","2021-05-06","2021-06-01","2021-09-23","2021-09-23","2020-05-26","2020-05-26","2021-09-23","2020-07-29","2021-06-30","2021-09-20","2021-08-23","2021-03-08","2020-08-06","2021-06-01","2020-12-22","2021-04-09","2021-09-20","2021-05-06","2020-10-16","2021-05-10","2021-08-18","2020-10-15","2021-01-07","2021-02-16","2021-01-07","2021-07-07","2021-01-07","2021-01-22","2021-04-12","2021-06-28","2021-07-08","2021-06-01","2021-06-17","2021-06-17","2021-06-17","2021-03-22","2020-01-14","2020-04-13","2020-01-29","2021-08-18","2020-10-16","2020-10-16","2021-05-08","2020-11-12","2020-11-12","2020-11-12","2020-11-12","2021-01-12","2021-05-08","2021-03-02","2021-03-22","2021-09-23","2021-09-09","2021-08-18","2021-09-09","2021-07-22","2020-02-25","2020-10-26","2020-10-26","2021-08-05","2020-04-13","2020-11-19","2020-12-22","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2021-07-07","2021-07-07","2021-08-18","2020-03-09","2020-09-17","2020-09-17","2020-11-06","2020-12-18","2021-05-10","2021-05-10","2021-05-10","2020-01-04","2020-01-04","2020-03-03","2020-03-03","2020-03-05","2020-03-05","2021-08-13","2021-08-05","2021-08-05","2021-07-22","2021-08-05","2021-04-09","2021-04-09","2021-05-04","2021-05-04","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2020-02-07","2020-02-10","2020-02-10","2020-10-16","2020-08-22","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2021-08-18","2021-08-18","2021-08-18","2020-10-16","2020-11-23","2020-03-25","2020-03-25","2020-03-25","2020-10-06","2020-10-13","2020-10-22","2020-10-14","2020-11-11","2020-11-11","2021-01-18","2021-06-28","2021-06-30","2021-06-30","2021-06-30","2021-05-08","2021-08-13","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-09","2021-08-09","2021-08-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-23"],"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":[["","42858010201","OXYCOD\/APAP ","5-325MG","60","Select","Select",""],["","65862052405","GABAPENTIN ","800MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","61442010210","DICLOFENAC ","50MG DR","14","Select","Select",""],["","00536136223","NICOTINE ","2MG","110","Select","Select",""],["","49035061244","","","110","Select","Select",""],["","67877025145","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","00115132019","COLESEVELAM ","625MG","120","Select","Select",""],["","65162044210","MECLIZINE ","25MG","30","Select","Select",""],["","51672128901","NYSTATIN ","100000","1","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","30","Select","Select",""],["","51672300302","HYDROCORT ","2.50%","28","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","60505025103","TIZANIDINE ","2MG","30","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","50458057930","XARELTO ","20MG","50","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","60","Select","Select",""],["","70710114003","FLUCONAZOLE ","200MG","90","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","150","Select","Select",""],["","00085461001","DULERA ","200-5MCG","13","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","59779044874","CVS ","21MG\/24H","42","Select","Select",""],["","00172392570","DIAZEPAM ","2MG","1","Select","Select",""],["","59762374401","CLINDAMYCIN ","10MG\/ML","60","Select","Select",""],["","00378647097","SCOPOLAMINE ","1MG\/3DAY","10","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","20","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","16","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90","Select","Select",""],["","42192080201","PHENAZOPYRID ","200MG","9","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00003376474","ELIQUIS ","5MG","74","Select","Select",""],["","00093005805","TRAMADOL ","50MG","12","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","15","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00603459321","METHYLPRED ","4MG","21","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","30","Select","Select",""],["","00527518070","SMZ-TMP ","200-40\/5","473","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","61442010210","DICLOFENAC","50MG DR","14","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","30","Select","Select",""],["","65862052405","GABAPENTIN","800MG","90","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","60","Select","Select",""],["","00536136223","NICOTINE","2MG","110","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","51672300302","HYDROCORT","2.50%","28","Select","Select",""],["","51672128901","NYSTATIN","100000","1","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","30","Select","Select",""],["","67877025145","TRIAMCINOLON","0.10%","454","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","60505025103","TIZANIDINE","2MG","30","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","150","Select","Select",""],["","10702001150","HYDROXYZ","25MG","60","Select","Select",""],["","00069046903","CHANTIX","1MG","56","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","42192080201","PHENAZOPYRID","200MG","9","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","00003376474","ELIQUIS","5MG","74","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","15","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","00378647097","SCOPOLAMINE","1MG\/3DAY","9","Select","Select",""],["","50458057830","XARELTO","15MG","40","Select","Select",""],["","00093005805","TRAMADOL","50MG","12","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","00603459321","METHYLPRED","4MG","21","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","53489011905","DOXYCYCL","100MG","30","Select","Select",""],["","59762374401","CLINDAMYCIN","10MG\/ML","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00527518070","SMZ-TMP","200-40\/5","473","Select","Select",""],["","00172392570","DIAZEPAM","2MG","1","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00603188016","LIDOCAINE","5%","4","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","70010075405","METHOCARBAM","500MG","120","Select","Select",""],["","00115132019","COLESEVELAM","625MG","120","Select","Select",""],["","65162044210","MECLIZINE","25MG","30","Select","Select",""],["","59779044874","CVS","21MG\/24H","42","Select","Select",""],["","68462010530","ONDANSETRON","4MG","16","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":""}]}]}