{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANI   T WHITAKER","gend":1,"add":"1309 PERSHING CT","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1982-01-21","age":"","mstatus":"","insh":"3228541*01","cliId":"","pno":"757\/776-5352","cno":"757\/776-5352","email":"","ename":"","eno":"","pphy":"PIPER, ALYSE Y PA","ppno":"757\/507-0305","pcpadd":"STE 300 1950 GLEN MITCHELL DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":140395,"pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/416-1934","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-0306","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.30","K92.1","Z20.822","F33.2","R05.","R06.02","R00.0","I49.3","I49.1","R00.2","J45.901","B35.3","J45.41","F41.9","J01.00","J30.1","I10.","R21.","N92.1","N64.4","D12.2","D12.5","K64.8","Z12.11","K63.5","D50.9","Z11.1","E66.01","J45.20","R10.2","L30.9","K62.5","M54.5","R11.2","R19.7","R42.","U07.1","Z20.828","R10.32","R30.0","M62.838"],"date":["2020-06-22","2021-04-01","2021-03-29","2020-08-16","2020-11-03","2020-11-03","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2020-01-11","2020-02-11","2020-01-16","2021-07-23","2021-05-24","2021-05-24","2021-08-02","2021-04-28","2021-04-28","2021-04-28","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-06-21","2021-06-28","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2021-02-22","2021-02-22","2021-07-08","2021-10-27","2021-07-23","2021-09-17","2021-09-27","2021-10-27","2021-10-27","2021-10-27"],"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":[["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","65862007930","TERBINAFINE ","250MG","14","Select","Select",""],["","50228014605","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","00378400305","ALPRAZOLAM ","0.5MG","10","Select","Select",""],["","00054001925","PREDNISONE ","50MG","4","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","00555902658","JUNEL ","Jan-20","28","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","28","Select","Select",""],["","68907634921","","","1","Select","Select",""],["","16714040604","LARIN ","Jan-20","28","Select","Select",""],["","00085461001","DULERA ","200-5MCG","13","Select","Select",""],["","16837085520","PEPCID ","20MG","28","Select","Select",""],["","69097012303","TOPIRAMATE ","50MG","60","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","50742061501","METOPROL ","25MG ER","30","Select","Select",""],["","11822527930","ACID ","20MG","28","Select","Select",""],["","59762219803","AZITHROMYCIN ","250MG","6","Select","Select",""],["","27808008601","HYD ","10-8\/5ML","100","Select","Select",""],["","57237004101","PENICILLN ","500MG","28","Select","Select",""],["","50383008716","GUAIATUSS ","100-10\/5","100","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","43598021055","SSD ","1%","50","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","60505095303","AZEL\/FLUTIC ","137-50","23","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","68180035109","SERTRALINE ","25MG","30","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","00054001925","PREDNISONE","50MG","4","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","50228014605","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","65862007930","TERBINAFINE","250MG","14","Select","Select",""],["","00378400305","ALPRAZOLAM","0.5MG","10","Select","Select",""],["","51672129801","KETOCONAZOLE","2%","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00555902658","JUNEL","Jan-20","28","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","28","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","60","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","11822527930","ACID","20MG","28","Select","Select",""],["","16837085520","PEPCID","20MG","28","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","57237004101","PENICILLN","500MG","28","Select","Select",""],["","27808008601","HYD","10-8\/5ML","100","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","16714040604","LARIN","Jan-20","28","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","30","Select","Select",""],["","50742061501","METOPROL","25MG ER","30","Select","Select",""],["","43598021055","SSD","1%","50","Select","Select",""],["","60505095303","AZEL\/FLUTIC","137-50","23","Select","Select",""],["","68180035109","SERTRALINE","25MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59762219803","AZITHROMYCIN","250MG","6","Select","Select",""],["","50383008716","GUAIATUSS","100-10\/5","100","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","65862019301","FLUOXETINE ","CAP 20MG","30","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","",""],["N\/A","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":""}]}]}