{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GRADY   C CARMACK","gend":0,"add":"205 FRANKLIN AVE APT A","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1979-06-17","age":"","mstatus":"","insh":"20025005*01","cliId":"","pno":"757\/673-7468","cno":"757\/319-5540","email":"","ename":"","eno":"","pphy":"GOODMAN, BENJAMIN MD","ppno":"757\/446-8920","pcpadd":"825 FAIRFAX AVE SUITE 445","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Hospital Medicine Physicians - SNGH","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5242","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","Z13.220","G62.9","F10.239","R10.9","F33.1","Z21.","K21.9","J45.909","R53.83","F14.23","F32.9","R21.","Z68.20","F12.20","F14.20","F33.2","F12.90","F17.210","G47.00","F34.89","F10.24","F14.24","F81.9","I10.","F11.23","Z11.3","M47.816","Z23.","T50.905A","Z00.00","Z87.09","J06.9","R05.","R09.82","E55.9","R13.12","M79.673","F41.9","F10.20","M54.9","G47.30","K29.60","M77.41","L85.3","M77.42","M79.672","F17.200","L02.416","Z79.899","S59.902A","K29.00","Z71.0","S62.114A","M20.021","M79.641","L85.1","M79.674","L30.9","Z76.0","R00.2","V54.12","M54.5","Z11.59","Z79.1","R10.84","Z72.89","M79.89","NO DATA","F15.23","R52.","S20.211A","R03.0","Z20.822","M79.646","K02.9","Z68.21","R07.81"],"date":["2022-09-29","2022-09-29","2020-07-22","2022-06-12","2021-12-30","2020-07-26","2022-08-22","2022-09-29","2022-06-08","2022-06-08","2022-06-12","2021-06-17","2021-03-10","2021-06-17","2021-06-17","2021-06-17","2022-02-12","2021-12-28","2022-08-22","2021-12-28","2019-04-12","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2022-06-12","2022-09-29","2020-01-02","2022-09-29","2020-01-02","2020-01-02","2020-01-02","2022-08-22","2020-02-01","2020-02-01","2022-09-29","2020-07-22","2020-07-22","2022-09-29","2019-08-03","2019-04-05","2019-04-05","2019-04-05","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2022-01-14","2020-09-14","2022-08-22","2020-09-14","2019-04-06","2019-08-09","2021-12-09","2022-02-10","2021-12-09","2020-04-08","2020-04-08","2021-03-10","2021-03-10","2021-06-18","2021-12-22","2019-08-03","2021-01-11","2022-01-14","2021-12-30","2021-12-30","2022-01-14","2022-09-29","2022-06-07","2022-01-26","2022-08-22","2022-08-22","2022-08-22","2022-09-29","2022-09-29","2022-02-10","2022-08-22"],"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":[["","00406051201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","","BIKTARVY"," BIKTARVY ","30","Select","Select",""],["","27808023402","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG DR","","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","90","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","00067628171","MAALOX","SUS ADVANCED","355","Select","Select",""],["","00187510001","ELIDEL","CRE 0.01","30","Select","Select",""],["","68682011001","PIMECROLIMUS","CRE 0.01","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","10135014901","DIPHENHYDRAM","CAP 25MG","16","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","16","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","9","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","12","Select","Select",""],["","59676057530","PREZCOBIX","TAB 800-150","30","Select","Select",""],["","","VITAMIN","TAB 50000UNI","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","PREGABALIN","CAP 25MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","AMMONIUM","CRE 0.12","","Select","Select",""],["","","ESOMEPRA","CAP 40MG DR","","Select","Select",""],["","","PRAZOSIN","CAP 2MG","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","AMITRIPTYLIN","TAB 10MG","","Select","Select",""],["","","MUPIROCIN","CRE 0.02","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","REXULTI","TAB 2MG","","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","","BUPROPION","TAB 100MG SR","","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":""}]}]}