{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMARA SELVIDGE","gend":1,"add":"2816 PINEWOOD DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1961-07-02","age":"","mstatus":"","insh":"20038858*01","cliId":"","pno":"757\/620-1868","cno":"757\/620-1868","email":"","ename":"","eno":"","pphy":"BAKHSHI, RAJA M MD","ppno":"757\/395-6900","pcpadd":"984B LASKIN ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":117346,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/425-7180","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","Z00.00","E11.8","I47.1","E66.01","I10.","N28.1","Z12.39","Z12.4","E55.9","H60.391","Z20.828","R19.7","G47.33","K21.9","E03.9","Z99.89","F33.3","F41.1","F60.3","F60.7","F33.1","R42.","R50.9","H65.92","D35.00","F33.2","F60.4","R00.2","R06.02","R53.81","R53.83","M79.7","Z12.11","Z86.010","R10.9","N28.89","E27.8","R10.11","R63.4","Z63.4","E78.2","I51.7","G47.30","M15.9","E66.9","M19.90","F33.9","F90.0","F41.0","R45.1","R10.33","D35.02","F34.1","R73.03","J32.9","R69.","F31.12","R00.0","R05.","R30.0","G47.00","Z72.821","R40.0","Z71.89"],"date":["2021-11-10","2020-07-28","2020-09-24","2020-09-28","2020-09-28","2021-03-04","2020-07-28","2020-07-28","2020-07-28","2021-03-04","2020-08-27","2021-04-14","2020-08-27","2021-10-18","2020-09-28","2021-03-04","2021-10-18","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-11-17","2020-01-20","2020-01-09","2020-01-09","2020-01-20","2020-05-20","2020-05-20","2020-01-13","2020-01-19","2020-01-19","2021-10-18","2020-07-27","2020-02-19","2020-02-19","2020-02-19","2020-08-31","2020-08-31","2020-01-21","2020-01-21","2020-02-24","2021-03-04","2021-10-18","2020-05-14","2020-05-14","2020-05-15","2020-05-15","2020-02-21","2020-02-21","2020-02-21","2020-05-13","2020-01-18","2020-01-18","2020-04-22","2020-04-22","2020-04-22","2020-05-24","2021-05-03","2020-01-13","2021-04-14","2021-08-23","2021-10-18","2021-10-18","2021-10-18","2021-10-18"],"priorHcc":[null,"","","","","","","","","","","","",null,"","",null,"","","","",null,"","","","","","","","","",null,"","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","",null,null,null,null]}},{"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":[["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30","Select","Select",""],["","37000045502","PRILOSEC ","20MG","28","Select","Select",""],["","45963070911","METOPROL ","25MG ER","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","59762045001","COLESTIPOL ","1GM","60","Select","Select",""],["","00378210001","LOPERAMIDE ","2MG","20","Select","Select",""],["","00591079401","DICYCLOMINE ","10MG","90","Select","Select",""],["","65862052790","VENLAFAXINE ","37.5 ER","30","Select","Select",""],["","67877024801","QUETIAPINE ","400MG","14","Select","Select",""],["","00115180301","HYDROXYZ ","25MG","42","Select","Select",""],["","29300013510","CLONIDINE ","0.1MG","28","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","1%","30","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","60","Select","Select",""],["","00085096315","LOTRIMIN ","1%","12","Select","Select",""],["","51224002230","AZITHROMYCIN ","250MG","7","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","90","Select","Select",""],["","69238161606","OFLOXACIN ","0.3%OTIC","10","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","45963070911","METOPROL","25MG ER","30","Select","Select",""],["","59762045001","COLESTIPOL","1GM","60","Select","Select",""],["","00378210001","LOPERAMIDE","2MG","20","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","90","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","65862052790","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00085096315","LOTRIMIN","1%","12","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","30","Select","Select",""],["","64380078706","BUSPIRONE","7.5MG","30","Select","Select",""],["","00115180301","HYDROXYZ","25MG","42","Select","Select",""],["","51224002230","AZITHROMYCIN","250MG","7","Select","Select",""],["","29300013510","CLONIDINE","0.1MG","28","Select","Select",""],["","67877024601","QUETIAPINE","200MG","14","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","69238161606","OFLOXACIN","0.3%OTIC","10","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","69238183007","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","65162010150","GABAPENTIN","100MG","30","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","90","Select","Select",""],["","37000045502","PRILOSEC","20MG","28","Select","Select",""],["","00054418125","DEXAMETHASON ","TAB 1MG","1","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","69238183007","LEVOTHYROXIN ","TAB 25MCG","90","Select","Select",""],["","00713031788","CICLOPIROX ","SOL 0.08","7","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":""}]}]}