{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH   M WASHINGTON","gend":1,"add":"211 MARCELLA RD APT 333","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1954-09-12","age":"","mstatus":"","insh":"20036973*01","cliId":"","pno":"757\/660-2909","cno":"757\/660-2909","email":"","ename":"","eno":"","pphy":"FRANCIS, ALBERT H MD","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DRIVE","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":"757\/553-4759","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":["E89.0","M47.816","M54.5","M54.2","M50.30","G89.29","M47.22","Z01.818","M72.2","M79.671","M79.2","M24.571","M24.572","M21.6X1","M21.6X2","M79.672","N81.3","M54.12","M43.16","M54.16","S16.1XXA","S39.012A","M51.36","Z98.890","M85.89","E66.01","D69.6","N95.1","Z68.41","M47.812","Z23.","N81.2","N95.2","R23.8","R53.83","R03.0","M25.551","M25.552","S13.9XXA","NO DATA","M53.2X6","V58.89","V89.2XXD","M54.42","K21.0","M54.41","L30.9","N81.4","J45.909","E03.9","M19.90","M54.32","I82.4Z1","M62.830","R73.09","R53.1","R26.89"],"date":["2021-09-30","2021-11-04","2021-09-30","2021-05-11","2020-09-02","2021-05-11","2021-09-16","2021-07-08","2021-11-11","2021-11-11","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-11-11","2021-07-13","2020-01-14","2020-01-14","2020-01-14","2020-01-15","2020-01-15","2021-05-11","2021-05-11","2021-02-10","2021-10-11","2021-02-10","2021-02-10","2021-10-11","2021-05-11","2021-10-11","2021-05-17","2021-05-17","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2020-01-22","2021-11-11","2020-10-21","2020-01-17","2020-01-17","2020-08-14","2020-08-14","2020-08-14","2021-05-26","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-10-11","2021-08-23","2021-10-11","2021-08-23","2021-11-11","2021-11-11"],"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":[["","00378181510","LEVOTHYROXIN ","150MCG","30","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","40","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","60505264907","TIZANIDINE ","4MG","60","Select","Select",""],["","00013215036","ESTRING ","2MG","1","Select","Select",""],["","00378877035","ESTRADIOL ","0.01%","42","Select","Select",""],["","00378647099","SCOPOLAMINE ","1MG\/3DAY","4","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","00378064110","PREDNISONE ","10MG","21","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","60","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","68180095604","CLOBETASOL ","0.05%","60","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","2","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","30","Select","Select",""],["","75826011410","PHENAZOPYRID ","100MG","11","Select","Select",""],["","50428057834","CVS ","4%","10","Select","Select",""],["","10702001801","OXYCODONE ","5MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","50428166363","BISACODYL ","5MG EC","6","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","9","Select","Select",""],["","00378181510","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","40","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","28","Select","Select",""],["","60505264907","TIZANIDINE","4MG","60","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","60","Select","Select",""],["","70461012003","FLUAD","0.5ML","0","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","00013215036","ESTRING","2MG","1","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","13107008405","LORAZEPAM","1MG","2","Select","Select",""],["","00378647099","SCOPOLAMINE","1MG\/3DAY","4","Select","Select",""],["","00378877035","ESTRADIOL","0.01%","42","Select","Select",""],["","00378064110","PREDNISONE","10MG","21","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","68180095604","CLOBETASOL","0.05%","60","Select","Select",""],["","50428057834","CVS","4%","10","Select","Select",""],["","75826011410","PHENAZOPYRID","100MG","11","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","9","Select","Select",""],["","10702001801","OXYCODONE","5MG","30","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","50428166363","BISACODYL","5MG EC","6","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","0","Select","Select",""],["","69584061250","METHOCARBAM ","TAB 750MG","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":""}]}]}