{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JIMMIE L GOODE","gend":0,"add":"711 DARE RD","city":"YORKTOWN","state":"VA","zip":"23692-9998","dob":"1959-07-17","age":"","mstatus":"","insh":"1625044*01","cliId":"","pno":7578909444,"cno":7573801652,"email":"","ename":"","eno":"","pphy":"BARRETO, BEATA MD","ppno":7577363725,"pcpadd":"100 Enterprise Drive","pcpcity":"RANDOLPH","pcpstate":"VA","pcpzip":"23962-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Yorktown","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574317782,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","Z20.822","E11.9","E11.59","F17.200","Z79.4","I15.2","E11.69","Z13.220","E66.9","E78.5","D50.9","R79.9","D72.829","D75.839","D50.0","D12.0","D12.2","Z86.010","R91.8","D35.02","N28.1","F41.1","F41.9","F13.10","Z79.899","S83.241A","M17.11","M11.261","M25.561","Z23.","R09.81","Z71.85","D64.9","K57.90","K80.20","K76.0","E27.9","R10.84","R19.5","K22.70","K25.3","B96.81","Z56.6","Z12.5","K25.7","K90.0","Z12.11","L92.9","I10.","Z86.16","J30.1","K29.70","R73.09"],"date":["2021-08-19","2021-08-18","2023-09-25","2023-09-25","2021-08-18","2023-09-25","2023-09-25","2023-09-25","2022-09-19","2022-09-19","2023-09-25","2023-09-25","2023-01-03","2023-01-03","2023-01-03","2023-07-06","2023-01-19","2023-01-19","2023-01-19","2023-02-03","2023-02-03","2023-02-03","2023-09-25","2023-03-28","2023-03-28","2023-07-18","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2023-09-25","2022-12-02","2023-09-25","2023-01-11","2023-01-11","2023-02-03","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-03-20","2023-03-23","2023-03-23","2022-06-16","2023-07-18","2023-01-27","2023-01-31","2021-08-30","2023-02-03","2021-04-27","2021-10-05","2021-10-05","2023-03-23","2023-07-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111032201","GLIMEPIRIDE","4 MG","180","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5 MG","30","Select","Select",""],["","00006057761","JANUMET","50-1000 MG","180","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","60","Select","Select",""],["","31722012805","GEMFIBROZIL","TAB 600MG","180","Select","Select",""],["","33342007510","VALSART\/HCTZ","TAB 160-12.5","90","Select","Select",""],["","13107015490","PAROXETINE","TAB 10MG","90","Select","Select",""],["","65162083809","VALSARTAN","80 MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","24","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","58160081912","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","Select","Select",""],["","70461042010","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","89130202001","DUROLANE","INJ 60MG\/3ML","3","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","24208039830","IPRATROPIUM","SPR 0.0003","90","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","65162083809","VALSARTAN TAB","80MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","60","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","90","Select","Select",""],["","43547031209","VALSARTAN-HYDROCHLOROTHIAZIDE","160-12.5MG","90","Select","Select",""],["","42571012290","LEVOCETIRIZI TAB","5MG","90","Select","Select",""],["","31722012805","GEMFIBROZIL TAB","600MG","180","Select","Select",""],["","00228202950","ALPRAZOLAM TAB","0.5MG","60","Select","Select",""],["","13107015590","PAROXETINE TAB","20MG","90","Select","Select",""],["","33342007510","VALSART\/HCTZ TAB","160-12.5","90","Select","Select",""],["","55111032201","GLIMEPIRIDE TAB","4MG","180","Select","Select",""],["","00006057761","JANUMET TAB","50-1000","180","Select","Select",""],["","70377002911","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","45","Select","Select",""],["","69097083412","SERTRALINE TAB","50MG","90","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","48","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","48","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","2","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","60","Select","Select",""],["","00597015230","JARDIANCE","10 MG","90","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}