{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLY   J STEINS","gend":1,"add":"3500 SEWELLS POINT RD APT J","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1966-02-27","age":"","mstatus":"","insh":"20038871*01","cliId":"","pno":"757\/944-3591","cno":"757\/944-3591","email":"","ename":"","eno":"","pphy":"MOHAN, RAVINDER MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.12","G47.33","G24.01","R39.81","E88.81","I25.118","F17.200","Z95.5","E78.5","L40.9","Z11.1","H91.93","J44.9","T14.90XA","K21.9","K59.00","E11.9","Z71.9","I25.10","R06.02","H90.6","H73.813","H69.82"],"date":["2021-09-16","2021-07-21","2021-09-16","2021-04-16","2021-02-24","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-23","2021-05-18","2021-06-04","2021-06-04","2020-09-15","2020-11-17","2020-11-17","2020-11-17","2021-08-23","2020-01-28","2020-01-28","2021-08-06","2021-08-06","2021-08-06"],"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":[["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","59779027408","ASPIRIN ","81MG","30","Select","Select",""],["","72511076002","REPATHA ","140MG\/ML","6","Select","Select",""],["","00173071820","FLOVENT ","44MCG","11","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","14539067401","HYDROXYZ ","25MG","60","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","45963043864","ENULOSE ","10GM\/15","450","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","59148003913","REXULTI ","3MG","30","Select","Select",""],["","49884093547","DICLOFENAC ","1%","100","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","30","Select","Select",""],["","00378518693","PRASUGREL ","10MG","30","Select","Select",""],["","66993068030","OLANZAPINE ","2.5MG","30","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","50383079516","LACTULOSE ","10GM\/15","450","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","70370108001","INGREZZA ","80MG","30","Select","Select",""],["","58406003204","ENBREL ","50MG\/ML","8","Select","Select",""],["","69238115409","EZETIMIBE ","10MG","90","Select","Select",""],["","66993089749","AUG ","0.05%","50","Select","Select",""],["","68382065105","ISOSORB ","60MG ER","90","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","55513013760","OTEZLA ","30MG","60","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","50742024990","DILTIAZEM ","180MG ER","90","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","59148003913","REXULTI","3MG","30","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65162019050","NAPROXEN","500MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","14539067401","HYDROXYZ","25MG","60","Select","Select",""],["","72511076002","REPATHA","140MG\/ML","6","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","59779027408","ASPIRIN","81MG","30","Select","Select",""],["","00378518693","PRASUGREL","10MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","66993068030","OLANZAPINE","2.5MG","30","Select","Select",""],["","45963043864","ENULOSE","10GM\/15","450","Select","Select",""],["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","50383079516","LACTULOSE","10GM\/15","450","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00173071820","FLOVENT","44MCG","11","Select","Select",""],["","68382065105","ISOSORB","60MG ER","90","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","70370108001","INGREZZA","80MG","30","Select","Select",""],["","69238115409","EZETIMIBE","10MG","90","Select","Select",""],["","58406003204","ENBREL","50MG\/ML","8","Select","Select",""],["","55513036955","OTEZLA","10\/20\/30","55","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","66993089749","AUG","0.05%","50","Select","Select",""],["","00168003315","BETAMETH","0.10%","60","Select","Select",""],["","50742024990","DILTIAZEM","180MG ER","90","Select","Select",""],["","00168003315","BETAMETH ","OIN 0.001","60","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","33332032101","AFLURIA ","INJ 2021-22","0","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":""}]}]}