{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERICA   L PAULHUS","gend":1,"add":"7448 FENNER ST APT 1","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1985-04-28","age":"","mstatus":"","insh":"1131042*01","cliId":"","pno":"757\/202-9851","cno":"","email":"","ename":"","eno":"","pphy":"VANDENHOFF, STEPHEN E MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9004","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","R92.8","S49.91XA","R11.2","R10.13","I82.401","N12.","Z72.0","F31.9","F41.1","F90.1","M25.511","H66.92","J98.8","Z88.0","R68.89","L03.313","B37.3","B37.9","I10.","E66.01","Z68.35","Z87.828","NO DATA","K31.84","E11.43","F17.210","Z11.1","S39.92XA","M54.42","K31.89","M79.661","M25.561","M79.89","R60.0","K13.79","F31.12","E27.8","D35.2","M54.9","Z04.1","R20.2","E11.9","M79.604","R10.9","R10.32","R35.0","Z01.818","Z01.812","Z20.822","B96.20","Z16.11","Z16.29","Z86.14","R39.15","Z23.","N20.0","J03.90","N92.6","E66.9","Z87.898","E27.9","Z32.01","O26.21","T21.22XA","T31.0","R21.","F41.9","F90.0","Z86.69","Z86.32","Z87.81","Z98.890","Z86.39","Z79.899","N76.89","J45.21","R07.89","S63.682A","Z01.30","O10.911","H66.002","H60.8X2","J45.901","W01.0XXA","D49.7","Z76.89","F43.10","L29.9","F12.90","Z34.91","O26.619","O24.111","K76.0","D72.829","F12.10","K04.01","J20.9","O02.1","K02.9"],"date":["2021-08-31","2020-11-04","2020-11-04","2021-10-27","2021-07-20","2021-08-30","2021-10-13","2021-10-26","2021-11-01","2021-11-01","2021-11-01","2020-11-02","2020-01-18","2020-01-18","2021-10-27","2020-01-18","2020-01-27","2020-04-23","2020-04-23","2021-10-26","2021-04-06","2021-04-06","2020-11-02","2021-10-26","2021-10-26","2021-10-26","2021-10-27","2021-05-29","2021-05-04","2021-03-26","2021-06-11","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-04-06","2021-04-06","2021-04-06","2021-05-03","2021-05-03","2021-08-31","2021-10-08","2021-08-31","2021-10-27","2021-10-27","2021-10-27","2021-06-08","2021-06-08","2021-06-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-27","2021-10-27","2019-02-03","2019-05-20","2019-06-06","2019-06-06","2019-06-06","2019-06-11","2019-06-24","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-08-15","2019-10-07","2019-10-07","2019-04-16","2019-06-24","2019-06-24","2019-04-14","2019-04-14","2019-04-14","2019-04-16","2019-05-22","2019-05-22","2019-05-22","2019-05-22","2019-05-22","2019-06-22","2019-06-22","2019-06-22","2019-06-22","2019-06-22","2019-06-22","2019-08-24","2019-12-19","2019-07-19","2019-08-24"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","10702000350","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","23155010205","METFORMIN","TAB 500MG","60","Select","Select",""],["","00093727156","PIOGLITAZONE","TAB 15MG","90","Select","Select",""],["","00555097302","AMPHET\/DEXTR","TAB 20MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00228203150","ALPRAZOLAM","TAB 1MG","30","Select","Select",""],["","","BYDUREON","INJ 2MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","30","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","200","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","15","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00713052612","PROMETHEGAN","SUP 25MG","10","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","00093007301","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","6","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","","OZEMPIC","INJ 2\/1.5ML","","Select","Select",""],["","64679096101","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","","AFRIN","SPR 0.0005","","Select","Select",""],["","00781598801","CARBAMAZEPIN","TAB 400MG ER","60","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","15","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","24208041005","OFLOXACIN","DRO 0.3%OTIC","5","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","69452023320","PROGESTERONE","CAP 100MG","60","Select","Select",""],["","52544025612","CRINONE","GEL 8% VAG","34","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","4","Select","Select",""],["","68682010810","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","04351098510","AEROCHAMBER","MIS MV","1","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","63824005736","MUCINEX","TAB 60-600MG","36","Select","Select",""],["","59762100501","CABERGOLINE","TAB 0.5MG","5","Select","Select",""],["","49884068905","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","25","Select","Select",""],["","59779048478","PAIN","TAB 500MG","80","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","11509020440","CEPACOL","LOZ 10-2.1MG","18","Select","Select",""],["","08373917700","VALVD","MIS CHAMBER","1","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":""}]}]}