{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDITH JOHNSON","gend":1,"add":"3136 FAIRVIEW ST APT 101","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1963-09-07","age":"","mstatus":"","insh":"20008509*01","cliId":"","pno":"757\/968-1190","cno":"","email":"","ename":"","eno":"","pphy":"FRUCCI, JANICE B PA","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/318-6901","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.412","Z17.0","M79.671","M72.2","M79.672","M21.619","M21.41","M21.42","L91.8","L21.9","Z71.9","M25.551","M53.3","M25.552","G89.29","M06.051","R70.0","M06.052","Z13.820","E66.01","E78.2","Z51.81","M54.5","Z00.00","Z98.84","K75.81","Z85.3","J45.20","Z68.43","S80.02XA","S93.401A","S93.601A","D17.1","J45.30","R79.82","R73.03","Z12.39","Z08.","Z80.3","L03.031","M79.605","L73.9","M25.571","J20.9","Z11.59","K90.9","K21.9","Z90.12","R22.2","Z01.419","Z76.89","Z12.31","S92.214A","Z20.828","Z68.41","M54.41","M46.1","R93.89","N85.01","Z68.42","Z23.","N85.02","E66.9","M79.2","M62.838","N95.0","R87.611","K62.89","I10.","N84.0","A51.31","Z01.818","N64.4","Z90.710","Z90.722","Z90.79","G43.C0","H57.11","N90.89","R87.810","N85.00","N84.1","J02.0","L25.9","Z78.0","Z01.411"],"date":["2021-02-05","2021-02-05","2021-04-15","2021-12-16","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-09-16","2021-09-16","2021-09-16","2021-09-30","2021-04-05","2021-09-30","2021-09-30","2021-01-05","2021-09-22","2021-01-05","2021-04-22","2021-09-30","2021-09-30","2021-04-22","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-12-09","2021-12-09","2021-12-16","2020-03-25","2020-05-07","2020-11-04","2020-05-07","2021-09-20","2021-09-20","2020-09-17","2020-10-29","2021-12-14","2021-12-14","2021-12-17","2020-01-08","2020-10-19","2021-06-03","2021-06-03","2021-10-14","2020-03-23","2021-02-25","2021-06-15","2021-09-20","2021-12-16","2021-12-27","2019-05-01","2019-07-31","2019-07-31","2019-09-10","2019-11-18","2019-10-30","2019-11-11","2019-11-18","2019-11-18","2019-09-23","2019-09-23","2019-08-26","2019-08-26","2019-08-26","2019-12-05","2019-08-26","2019-08-26","2019-11-04","2019-12-17","2019-12-17","2019-12-17","2019-12-17","2019-08-14","2019-09-28","2019-12-23","2019-07-23","2019-07-23","2019-07-23","2019-05-11","2019-08-06","2019-04-04","2019-06-25"],"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":[["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","70710115803","LEFLUNOMIDE","TAB 20MG","4","Select","Select",""],["","","FOLIC","TAB 1MG","","Select","Select",""],["","68382009601","HYDROXYCHLOR","TAB 200MG","60","Select","Select",""],["","","CLOTRIM\/BETA"," CLOTRIM\/BETA ","15","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","VALACYCLOVIR"," VALACYCLOVIR ","10","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","00591367101","NABUMETONE","TAB 750MG","60","Select","Select",""],["","","FLOVENT"," FLOVENT ","11","Select","Select",""],["","","ZETIA"," ZETIA ","30","Select","Select",""],["","","TAMOXIFEN"," TAMOXIFEN ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","TIZANIDINE"," TIZANIDINE ","30","Select","Select",""],["","","TOPIRAMATE"," TOPIRAMATE ","60","Select","Select",""],["","","EZETIMIBE"," EZETIMIBE ","30","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","SILVER"," SILVER ","100","Select","Select",""],["","","SSD"," SSD ","100","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","20","Select","Select",""],["","","NYSTATIN"," NYSTATIN ","15","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","30","Select","Select",""],["","","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","Select","Select",""],["","","METHOTREXATE","TAB 2.5MG","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}