{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA   L KINCAID","gend":1,"add":"146 RANCH DR","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1973-04-11","age":"","mstatus":"","insh":"20030622*01","cliId":"","pno":"757\/240-9276","cno":"757\/240-9276","email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":"757\/594-1850","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-1841","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.9","F41.9","F19.20","N39.41","H10.013","R05.","S63.297A","Z01.419","Z12.4","K43.2","K27.9","R31.9","N95.2","F31.89","R35.0","Z00.00","N39.0","L30.9","R53.83","N30.00","J20.9","Z72.0","N92.5","N83.291","Z23.","N30.01","F23.","Z86.59","Z91.89","F25.1","F43.10","F41.1","R41.9","E55.9","R15.9","Z91.51","F17.210","K21.9","Z20.828","F17.200","Z12.31","R44.3","F29.","Z76.89","B85.2","Z12.39","Z13.220","R06.02","J18.9","T76.21XA","J02.9","H65.03","H60.91","G56.01","Z02.89","M25.511","F25.0","Z13.9","J06.9","Z48.815","F31.9","F20.9","R56.9","K62.2","Z71.6","Z01.818","K43.6","K43.0","R41.82","K62.3","K25.9","K59.00","Q43.8","Z96.89","B85.0","T43.592A","R03.0","L20.9","R10.84","N92.0","R10.11","Z96.652","Z79.899","Z88.8","K62.5","F33.3","F43.12","F31.4","M25.531","R45.86","R20.0","N92.6","T50.902A","T14.91XA","R10.9","F31.64"],"date":["2021-12-29","2021-12-29","2021-12-29","2021-12-12","2020-04-08","2020-11-10","2021-08-31","2021-09-16","2020-08-31","2020-09-16","2020-09-16","2020-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-12-08","2021-12-08","2021-12-07","2021-07-28","2020-10-26","2021-11-01","2020-11-05","2020-11-05","2020-11-05","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-17","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-28","2021-12-28","2021-12-17","2021-05-15","2021-07-28","2021-07-28","2021-12-20","2021-12-20","2021-12-20","2020-08-27","2020-08-27","2020-08-27","2021-04-07","2021-04-07","2020-07-15","2020-12-15","2020-12-15","2021-05-22","2021-05-22","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-11-01","2019-10-17","2019-10-17","2019-10-17","2019-10-17","2019-09-05","2019-09-05","2019-09-30","2019-03-04","2019-03-20","2019-04-25","2019-10-11","2019-10-07","2019-10-07","2019-10-07","2019-10-07","2019-01-15","2019-04-14","2019-04-16","2019-04-27","2019-04-25","2019-04-26","2019-04-26","2019-04-26","2019-04-26","2019-04-26","2019-08-11","2019-04-15","2019-04-15","2019-04-15","2019-12-11","2019-12-11","2019-12-11","2019-02-11","2019-04-15","2019-04-15","2019-04-27","2021-12-13"],"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":[["","29300013505","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","67877022401","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","69315013701","BENZTROPINE","TAB 1MG","60","Select","Select",""],["","29300015001","QUETIAPINE","TAB 200MG","90","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","60505131703","PAROXETINE","TAB 25MG ER","30","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","WIXELA","AER 250\/50","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","10","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","60505082601","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","65862001330","SERTRALINE","TAB 100MG","30","Select","Select",""],["","11822300930","SENNA","TAB 8.6-50MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","43547027509","DONEPEZIL","TAB 5MG","30","Select","Select",""],["","68382007901","HALOPERIDOL","TAB 5MG","15","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","","PALIPERIDONE","TAB ER 3MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","51672529404","MALATHION","LOT 0.005","59","Select","Select",""],["","","FIBER","CAP 0.52GM","","Select","Select",""],["","11822003960","RA","CAP 100MG","60","Select","Select",""],["","","METAMUCIL","CAP 0.52GM","","Select","Select",""],["","","PAIN","TAB 325MG","","Select","Select",""],["","","IBUPROFEN","TAB 400MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","GNP","CAP 0.52GM","","Select","Select",""],["","","INVEGA","INJ 156MG\/ML","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","TH","CAP 0.52GM","","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","120","Select","Select",""],["","16729016801","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","00904645760","DOK","CAP 100MG","60","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","20","Select","Select",""],["","50383056510","NEOMYCIN","TAB 500MG","6","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","62332001731","METRONIDAZOL","TAB 500MG","6","Select","Select",""],["","11822333000","MAG","SOL LEMON","592","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":""}]}]}