{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA GARRIS","gend":1,"add":"504 MINUNTE MAN ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1962-06-30","age":"","mstatus":"","insh":"20001218*01","cliId":"","pno":"757\/395-7289","cno":"","email":"","ename":"","eno":"","pphy":"LIPTON, ERIC MD","ppno":"757\/363-6848","pcpadd":"SUITE 100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9033","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","I80.02","J01.90","J96.01","J18.9","N30.00","C78.00","Z68.41","I13.0","I50.32","E87.1","C50.919","Z20.828","J45.909","E87.70","E66.01","NO DATA","D63.8","D69.6","F06.4","R06.03","B37.0","D50.0","D64.81","K29.60","R79.89","N17.9","I82.5Z2","R04.0","D63.1","C78.01","Z85.3","I50.9","N39.0","K64.8","K62.5","I10.","D64.9","G89.3","R53.1","Z51.5","R53.81","C90.10","E88.3","D63.0","D69.59","I48.91","J12.81","B37.3","N20.0","M79.652","I12.9","N18.3","M25.472","C50.912","E66.3","Z23.","Z79.899","D70.9","I82.402","Z79.01","K57.92","R06.00","I82.812","R07.9","R06.02","R05.","R11.0","R19.7","C90.00","C79.9","K21.9","G93.2","F32.9","J45.20","I34.1","K44.9","N18.9","N95.2","R10.2","R91.8","R93.89","Z17.0","Z90.13","I80.292","U07.1","I50.33","Z66.","C85.90","G72.81","R44.3","L98.9","J01.00","M25.561","M17.11","R60.0","R12.","Z92.21","K29.50","R82.81","D48.5","D72.829","Z85.118","L30.8","M62.81","R26.9","I48.0","N17.1","I95.9","N18.4","A41.9","Z45.2","R26.89","R91.1","M79.605","R68.89","K57.32","F41.0","R45.89","D73.5","Z20.822","C50.011","C50.012","C50.911","D70.1","T45.1X5S","K29.51","D62.","I47.1","Z68.42","H54.7","T45.1X5A","R10.13","R31.9","K72.00","I50.31","D25.2","H25.13","H15.092","H35.362","K59.00","K52.9","B00.9","I51.7","D53.9","C50.811","S30.861A","L08.9","R10.9","R39.9","B37.9","N30.01","T36.95XA","R09.89","C80.1","N28.9","N17.0","G93.41","A41.89","R65.21","J15.9","E44.0","R11.2","H81.10","E66.9","M89.8X1","S60.949A","R06.2","R10.30","N89.8","R10.31","D17.1","L40.9","M79.9","H18.51","S39.012A","S29.019A","S16.1XXA","V87.7XXA","M54.9","R20.0","M54.2","I97.2","R10.11","H10.011","R07.89","F41.9","R73.9","V89.2XXD","R42.","Z90.11","Z90.12","B07.9","R30.0","M54.6","H83.09"],"date":["2020-08-03","2021-01-13","2020-12-02","2021-02-23","2020-12-16","2021-01-18","2021-02-10","2021-02-14","2021-02-14","2021-02-24","2021-02-24","2021-02-23","2020-12-22","2021-01-07","2020-12-16","2021-02-23","2021-02-24","2020-12-16","2021-02-21","2020-12-16","2020-12-19","2021-01-23","2021-02-21","2021-01-06","2021-01-06","2021-01-30","2021-02-23","2021-01-08","2021-01-13","2021-01-13","2021-01-21","2021-01-28","2021-02-22","2021-01-23","2021-01-18","2021-01-21","2021-02-20","2021-02-24","2021-02-10","2021-02-24","2021-02-25","2021-02-24","2021-02-23","2021-02-09","2021-02-11","2021-02-11","2021-02-24","2021-02-26","2020-02-07","2020-09-11","2020-08-07","2021-02-03","2020-09-11","2020-08-26","2021-01-18","2020-09-11","2020-09-24","2021-02-11","2020-10-29","2020-10-29","2020-12-04","2020-12-15","2020-12-22","2021-01-06","2021-02-18","2021-02-25","2021-01-06","2021-01-26","2021-01-10","2021-02-08","2021-01-18","2021-01-18","2021-01-18","2021-02-08","2021-01-30","2021-01-18","2021-01-18","2021-02-03","2020-02-07","2020-02-26","2020-05-18","2020-05-18","2021-01-21","2020-11-17","2020-08-12","2021-02-24","2021-02-17","2021-02-14","2021-01-23","2021-02-05","2021-01-23","2021-01-29","2020-03-03","2020-11-12","2020-11-12","2020-11-17","2020-11-17","2021-01-19","2021-02-08","2021-02-08","2021-01-28","2021-02-07","2021-01-28","2021-02-10","2021-02-05","2021-02-05","2021-02-24","2021-02-19","2021-02-24","2021-02-22","2021-02-07","2021-02-10","2021-02-11","2020-05-26","2020-08-26","2020-11-25","2020-12-11","2020-12-28","2020-12-28","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2020-03-17","2020-10-08","2020-10-08","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-18","2021-01-23","2021-02-19","2021-02-19","2020-04-02","2020-10-23","2020-10-23","2020-10-23","2020-12-04","2020-12-04","2020-12-04","2020-12-12","2020-12-19","2020-01-03","2020-05-07","2020-05-07","2020-05-15","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-12-10","2020-12-10","2021-01-25","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2019-04-01","2019-04-01","2019-09-13","2019-12-11","2019-07-15","2019-07-29","2019-01-17","2019-01-17","2019-01-17","2019-02-07","2019-02-07","2019-03-19","2019-10-18","2019-10-27","2019-10-27","2019-10-27","2019-10-27","2019-11-29","2019-11-29","2019-11-29","2019-05-30","2019-08-15","2019-06-20","2019-07-29","2019-09-27","2019-09-27","2019-11-05","2019-03-23","2019-05-31","2019-05-31","2019-06-28","2019-06-28","2019-11-20","2019-02-18"],"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":{"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":[["","","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","16","Select","Select",""],["","00574050801","FERROUS","TAB 324MG","30","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","48102004701","DEXAMETHASON","TAB 4MG","30","Select","Select",""],["","00591207030","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00574709012","HYDROCORT","SUP 25MG","9","Select","Select",""],["","00228202796","ALPRAZOLAM","TAB 0.25MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00904386575","DEEP","SPR 0.0065","44","Select","Select",""],["","00088502005","LANTUS","INJ 100\/ML","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","30","Select","Select",""],["","00006027754","JANUVIA","TAB 100MG","30","Select","Select",""],["","50458057990","XARELTO","TAB 20MG","30","Select","Select",""],["","","ELIQUIS","TAB 5MG","","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","10","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","25","Select","Select",""],["","63824000850","MUCINEX","TAB 600MG ER","28","Select","Select",""],["","24979003007","DILTIAZEM","CAP 360MG ER","30","Select","Select",""],["","52817036200","METOPROL","TAB 100MG","90","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","60","Select","Select",""],["","00527328046","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","13811052501","TRIPHROCAPS","CAP ","30","Select","Select",""],["","16714004210","ALLOPURINOL","TAB 300MG","30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","30","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","69076014601","ACYCLOVIR","CAP 200MG","52","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","","CLOTRIMAZOLE","CRE 1% VAG","","Select","Select",""],["","","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","00591024005","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","00093078701","ATENOLOL","TAB 25MG","30","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","","PREMARIN","CRE 0.625MG","","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","24","Select","Select",""],["","00168005960","FLUOCIN","SOL 0.0001","60","Select","Select",""],["","","IBRANCE","CAP 125MG","","Select","Select",""],["","","MUPIROCIN","CRE 0.02","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","","CEFUROXIME","TAB 250MG","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","AMOX\/K","TAB 250-125","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","12","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","51862044630","TAMOXIFEN","TAB 20MG","30","Select","Select",""],["","64980029410","SODIUM","TAB 10GR","90","Select","Select",""],["","11980002205","BLEPHAMIDE","SUS OP","5","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00065064705","TOBRADEX","SUS 0.3-0.1%","5","Select","Select",""],["","00591079021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00363040321","WAL-DRAM","TAB 25MG","60","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","12","Select","Select",""],["","61314064705","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","24208035805","ZYLET","SUS 0.5-0.3%","5","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","15","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}