{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAROLD   R WHITEHEAD","gend":0,"add":"5 LAKE WALK XING","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1957-01-06","age":"","mstatus":"","insh":"20037294*01","cliId":"","pno":"757\/236-3616","cno":"757\/236-3616","email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":"757\/594-1850","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":119880,"pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-1841","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.81","G47.33","R06.83","I20.9","R07.89","I25.10","I35.9","S60.222A","W22.8XXA","M19.042","J30.89","Z79.891","H40.1131","G25.0","F41.9","F32.9","Z99.89","M48.07","NO DATA","M47.896","J06.9","Z20.822","J30.1","R68.89","I73.9","R05.","J01.41","R21.","R06.02","J98.4","Z95.1","R41.3","G89.29","M54.5","M48.02","Z09.","I10.","Z23.","I25.118","E78.00","E78.2","J84.112","R07.9","R06.00","I50.32","R01.1","H90.3","F32.0","J02.9","T81.32XS","G47.00","Z48.812","Z95.5","Z79.02","Z79.82","E78.5","Z79.899","Z87.891","Z86.74","Z91.81","J84.9","V58.89","W22.8XXD","H69.83","H93.13","K21.9","M54.9","M46.1","I35.8","I35.0","D64.9","D53.9","S69.92XA","S22.23XK","R91.8","R06.09","H40.1121","Z00.00","Z13.220","Z12.5","Z96.1","R41.9","F41.1","D48.5","R09.81","J34.3","J34.2","G62.9","M51.36","T81.32XA","E66.3"],"date":["2020-04-06","2020-11-24","2020-06-02","2020-06-18","2021-03-15","2020-09-02","2020-09-02","2020-09-29","2020-09-29","2021-03-09","2021-09-08","2021-05-17","2021-08-26","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2021-02-15","2021-05-17","2021-05-17","2021-03-15","2021-03-15","2021-07-28","2020-02-05","2021-03-16","2021-07-28","2020-02-05","2020-02-05","2020-04-27","2020-06-23","2021-03-16","2020-11-12","2020-10-13","2020-11-10","2020-09-29","2020-09-24","2021-03-16","2020-11-11","2021-03-16","2020-11-11","2020-11-11","2021-03-16","2020-09-23","2020-09-08","2021-03-16","2020-09-08","2021-07-28","2021-03-16","2021-03-16","2021-04-09","2020-06-02","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-07-01","2020-08-03","2020-07-01","2020-07-01","2020-07-01","2020-12-28","2021-04-23","2021-03-09","2021-01-26","2020-07-29","2020-07-29","2020-08-20","2021-05-17","2020-07-09","2020-08-31","2020-09-16","2020-09-16","2020-09-16","2020-09-28","2020-12-28","2020-12-28","2021-04-22","2020-05-12","2020-05-12","2020-05-12","2020-07-23","2020-11-12","2020-11-12","2021-02-04","2020-01-29","2020-01-29","2020-01-29","2020-05-04","2020-05-04","2021-03-12","2021-07-28"],"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":[["","51672128202","TRIAMCINOLON","0.10%","60","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","2","Select","Select",""],["","00904645760","DOK ","100MG","30","Select","Select",""],["","00781569031","EZETIMIBE ","10MG","30","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","30","Select","Select",""],["","65862064169","AZITHROMYCIN ","250MG","6","Select","Select",""],["","50228042360","RANOLAZINE ","500MG ER","60","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","55513076002","REPATHA ","140MG\/ML","2","Select","Select",""],["","69315011710","FUROSEMIDE ","40MG","30","Select","Select",""],["","62175013637","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","67877022301","GABAPENTIN ","300MG","180","Select","Select",""],["","00591554301","ALLOPURINOL ","100MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","30","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","76385012401","METHOCARBAM ","750MG","90","Select","Select",""],["","51672128202","TRIAMCINOLON ","0.10%","60","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","62175012937","ISOSORB ","120MG ER","30","Select","Select",""],["","00023320505","LUMIGAN ","0.01%","5","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","30","Select","Select",""],["","00363021807","ASPIRIN-81 ","81MG","90","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5","Select","Select",""],["","00536100836","ASPIRIN ","81MG","90","Select","Select",""],["","24208048510","DORZOLAMIDE ","2% OP","20","Select","Select",""],["","65162062711","TRAMADOL ","50MG","120","Select","Select",""],["","70677003401","STOOL ","100MG","30","Select","Select",""],["","00781185220","AMOX\/K ","875-125","14","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","12843013105","BAYER ","81MG","90","Select","Select",""],["","00031875718","ROBIT ","20-200","120","Select","Select",""],["","00904672059","ACETAMIN ","500MG","20","Select","Select",""],["","24208050405","VYZULTA ","0.02%","5","Select","Select",""],["","42806040021","METHYLPRED ","4MG","21","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","30","Select","Select",""],["","00781569031","EZETIMIBE","10MG","30","Select","Select",""],["","62175012937","ISOSORB","120MG ER","30","Select","Select",""],["","59762033302","LATANOPROST","0.01%","2","Select","Select",""],["","62175013637","OMEPRAZOLE","40MG","30","Select","Select",""],["","76385012401","METHOCARBAM","750MG","90","Select","Select",""],["","68180035407","RANOLAZINE","500MG ER","60","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","30","Select","Select",""],["","67877022301","GABAPENTIN","300MG","180","Select","Select",""],["","00591554301","ALLOPURINOL","100MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","55513076002","REPATHA","140MG\/ML","2","Select","Select",""],["","00904645760","DOK","100MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","00363021879","ASPIRIN-81","81MG","90","Select","Select",""],["","00536100836","ASPIRIN","81MG","90","Select","Select",""],["","24208048510","DORZOLAMIDE","2% OP","10","Select","Select",""],["","00023320505","LUMIGAN","0.01%","5","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","65162062711","TRAMADOL","50MG","120","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00031875718","ROBIT","20-200","120","Select","Select",""],["","12843013105","BAYER","81MG","90","Select","Select",""],["","00904672059","ACETAMIN","500MG","20","Select","Select",""],["","00781185220","AMOX\/K","875-125","14","Select","Select",""],["","24208050405","VYZULTA","0.02%","5","Select","Select",""],["","70677003401","STOOL","100MG","30","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","45963070911","METOPROL ","TAB 25MG ER","90","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":""}]}]}