{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH WARREN","gend":1,"add":"10235 ESSIE DORIS LN APT E","city":"WINDSOR","state":"VA","zip":"23487-9998","dob":"1978-01-06","age":"","mstatus":"","insh":"6549691*01","cliId":"","pno":"757\/358-4883","cno":"757\/358-4883","email":"","ename":"","eno":"","pphy":"WEITZMAN, DOUGLAS K MD","ppno":"757\/542-2000","pcpadd":"STE 200 20209 SENTARA WAY","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":139535,"pcpname":"SMG - Sentara Family Medicine Physicians - St. Luke's","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/332-3630","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9266","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.0","J32.1","J32.2","J32.3","Z20.828","J20.9","F31.13","N92.4","N80.9","R10.30","J30.1","R05.","Z01.818","R32.","N93.8","F31.81","I10.","J45.909","K66.0","F20.9","N92.0","F41.1","M54.6","NO DATA","E66.09","Z68.36","L82.0","L91.8","B35.1","L02.821","L60.8","L73.2","M79.641","M25.511","W19.XXXA","J01.90","Z00.00","J45.20","E22.1","E55.9","Z86.69","J30.89","Z91.19"],"date":["2020-05-11","2020-05-11","2020-05-11","2020-05-11","2021-02-28","2021-02-28","2020-01-15","2020-05-29","2020-05-29","2020-05-29","2020-07-20","2020-05-11","2020-05-19","2020-05-19","2020-05-19","2021-08-25","2021-08-25","2020-05-29","2020-05-29","2021-08-25","2020-05-29","2020-04-06","2020-12-30","2021-08-25","2021-08-25","2020-12-30","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2020-02-06","2020-02-06","2021-05-21","2021-05-21","2021-05-21","2020-07-14","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25"],"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":[["","45802004635","GENTAMICIN ","0.10%","15","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","60","Select","Select",""],["","65862022960","LAMOTRIGINE ","150MG","60","Select","Select",""],["","43547028810","BUPROPION ","100MG SR","30","Select","Select",""],["","51672408103","CLINDAMYCIN ","1%","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","65862067899","ALPRAZOLAM ","1MG","60","Select","Select",""],["","00074003828","ORILISSA ","150MG","28","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00603233832","APAP\/CODEINE ","300-30MG","15","Select","Select",""],["","00904772714","ACID ","","450","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","21","Select","Select",""],["","65162047505","NORETHIN ","5MG","30","Select","Select",""],["","00378064110","PREDNISONE ","10MG","18","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","0","","","300","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","28","Select","Select",""],["","68682045570","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","50383026505","LOTEPREDNOL ","0.50%","5","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","60758088005","FLUOROMETHOL ","0.1% OP","15","Select","Select",""],["","31722057330","ESOMEPRA ","40MG DR","30","Select","Select",""],["","52565012215","LIDOCAINE ","4%","60","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","51672126301","NYSTAT\/TRIAM ","","15","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","30","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5","Select","Select",""],["","59762100501","CABERGOLINE ","0.5MG","4","Select","Select",""],["","00093005805","TRAMADOL ","50MG","18","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":""}]}]}