{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA HOLLIMAN","gend":1,"add":"1846 E LITTLE CREEK RD LOT 49","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1976-12-21","age":"","mstatus":"","insh":"7609620*01","cliId":"","pno":"757\/613-5804","cno":"757\/613-5804","email":"","ename":"","eno":"","pphy":"MPOY KANYINDA, JEAN MARIE K MD","ppno":"757\/388-9925","pcpadd":"7401 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/965-8519","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H00.011","H01.9","R63.1","Z23.","Z86.32","K76.0","E66.9","E55.9","E78.1","G47.33","L21.9","Z83.71","Z12.39","R10.9","M54.16","M51.26","M51.27","M54.31","E66.01","M51.36","M54.5","Z01.419","N76.0","B96.89","K57.32","R13.10","K80.20","R11.0","K21.9","H00.11","Z11.3","N91.2","M53.3","G89.29","M54.41","J06.9","R05.","Z12.31","K86.2","K02.9","M51.16"],"date":["2020-02-11","2020-02-11","2020-11-18","2020-11-18","2020-11-18","2021-05-18","2020-11-18","2021-08-18","2021-05-18","2021-05-18","2021-05-18","2020-11-18","2020-11-18","2020-12-09","2021-05-12","2021-05-18","2021-03-08","2021-03-08","2021-08-18","2021-08-18","2021-05-12","2020-05-11","2020-07-23","2020-05-11","2021-01-14","2021-01-14","2020-12-15","2020-12-15","2020-12-15","2020-02-06","2020-07-23","2020-07-30","2021-02-18","2021-02-18","2021-02-18","2020-04-23","2020-04-23","2021-05-18","2021-08-18","2021-08-18","2021-08-18"],"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":[["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","42135010000","COMPACT ","CHAMBER","1","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OP","4","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00591544210","PREDNISONE ","10MG","30","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","10","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","14","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90","Select","Select",""],["","65162062711","TRAMADOL ","50MG","36","Select","Select",""],["","00904674860","BISACODYL ","5MG EC","4","Select","Select",""],["","11523723403","MIRALAX ","3350 NF","238","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","10","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","24208091055","ERYTHROMYCIN","OP","4","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","42135010000","COMPACT","CHAMBER","1","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","14","Select","Select",""],["","00904674860","BISACODYL","5MG EC","4","Select","Select",""],["","11523723403","MIRALAX","3350 NF","238","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","36","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","10","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","65162010250","GABAPENTIN","300MG","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","",""],["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":""}]}]}