{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARCUS   D WHITE","gend":0,"add":"2011 WINFREE ROAD","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1958-02-21","age":"","mstatus":"","insh":"20037257*01","cliId":"","pno":"757\/298-2950","cno":"","email":"","ename":"","eno":"","pphy":"GLAVE, KRISTLE M NP","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Peninsula Towne","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/827-9978","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H44.001","E11.3311","E11.3312","E11.3553","E11.40","E11.69","E11.59","Z79.4","E78.5","I10.","Z79.84","R07.9","I25.110","I21.4","J18.1","I13.0","I50.9","E11.22","NO DATA","D63.1","E11.42","E11.43","E11.319","M19.90","D69.6","E55.9","H40.9","Z79.82","E11.628","N17.9","Z20.822","E08.621","L97.411","E11.621","L97.519","L02.611","Z09.","I50.23","I24.8","K21.9","M21.371","L97.412","I87.2","L97.512","L03.115","A41.9","I15.2","I50.33","I50.22","E11.3533","Z79.51","Z79.899","H40.1133","H40.022","H40.021","Z96.1","T81.31XA","E16.2","R33.9","G56.23","G62.9","N40.1","I50.43","E11.3593","B95.2","E78.2","N18.31","V58.89","H40.1132","H16.223","H16.222","H16.221","R41.82","E11.649","R10.9","J81.0","R33.8","K59.00","J96.01","R09.02","R10.84","R26.89","M62.81","Z20.828","R94.39","E11.9","N18.9","R06.02","M71.071","L97.429","I25.2","B35.1","Z87.898","E11.8","N25.81","J98.11","N39.0","E83.39","R60.0","E11.65","E34.9","N30.01","D64.9","I50.31","R09.81","S81.802A","S91.309A","I82.409","I51.7","I25.10","S91.312D","Z23.","E11.29","I25.118","I50.42","R06.2","J18.9","I50.32","Z80.9","R60.9","R05.","Z01.810","Z01.812","H20.9","H57.11","H20.051","J96.00","I70.235","S84.11XA","R73.09","R20.2","S91.109A","M79.89","M79.671","R42.","R50.9","S91.301A","E78.00","Z79.02","R61.","I77.810","Z01.818","Z91.19","Z12.5","D36.9","M25.511","Q55.9","H11.442","K21.0","Z11.59","Z11.4","E11.3319","E11.3313","H40.1122","Z12.11","R63.0","Z71.89","H40.1112","Z00.00","E88.81","Z12.12","R80.9","Z86.010"],"date":["2021-12-23","2021-12-23","2021-12-23","2021-11-22","2021-12-18","2021-11-22","2021-11-22","2021-12-18","2021-11-22","2021-12-18","2021-12-18","2021-04-02","2021-05-05","2021-08-11","2021-05-20","2021-05-31","2021-05-31","2021-10-01","2021-11-22","2021-10-01","2021-11-22","2021-10-01","2021-05-31","2021-10-01","2021-05-31","2021-08-11","2021-12-18","2021-12-18","2021-08-04","2021-05-05","2021-04-15","2021-05-05","2021-10-01","2021-10-01","2021-04-20","2021-04-20","2021-05-05","2021-05-05","2021-05-05","2021-09-28","2021-12-10","2021-09-29","2021-09-29","2021-07-28","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-08-04","2021-12-18","2021-09-23","2021-08-03","2021-08-03","2021-06-23","2021-09-29","2021-12-18","2021-11-29","2020-03-11","2020-03-11","2021-11-29","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-07-12","2021-08-11","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-12-18","2021-12-18","2020-02-13","2020-02-17","2020-02-24","2020-02-13","2020-02-17","2020-02-13","2020-02-13","2021-04-26","2020-07-02","2021-03-27","2021-03-31","2021-04-23","2021-04-02","2021-03-31","2021-08-20","2021-05-31","2021-05-31","2021-12-10","2021-11-29","2021-11-18","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2021-11-22","2020-02-24","2020-02-24","2021-03-28","2020-02-24","2021-04-09","2020-08-20","2020-08-31","2021-03-28","2021-03-30","2021-04-02","2021-07-09","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-09-28","2021-04-26","2021-03-28","2021-03-28","2021-04-15","2021-04-15","2021-10-13","2021-10-13","2020-04-02","2020-04-02","2020-04-02","2020-02-17","2021-04-16","2020-06-15","2020-06-15","2020-06-15","2020-07-20","2021-03-28","2021-04-15","2021-04-15","2021-04-15","2021-04-23","2021-12-18","2021-12-18","2021-12-18","2020-02-14","2021-09-28","2021-09-28","2021-09-28","2019-09-27","2019-01-02","2019-01-02","2019-06-26","2019-03-18","2019-03-18","2019-03-18","2019-04-04","2019-04-04","2019-06-24","2019-10-25","2019-12-09","2019-12-09","2019-05-20","2019-08-09","2019-08-09","2019-08-09","2019-09-05","2019-10-25"],"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":[["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","PRAVASTATIN"," PRAVASTATIN ","30","Select","Select",""],["","","METOPROL"," METOPROL ","60","Select","Select",""],["","","VITAMIN"," VITAMIN ","30","Select","Select",""],["","60505258009","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","","LANTUS"," LANTUS ","10","Select","Select",""],["","","VALSARTAN"," VALSARTAN ","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","","PREGABALIN"," PREGABALIN ","60","Select","Select",""],["","","SM"," SM ","30","Select","Select",""],["","16729021101","DOXAZOSIN","TAB 1MG","30","Select","Select",""],["","","BRIMONIDINE"," BRIMONIDINE ","10","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","24208048510","DORZOLAMIDE","SOL 2% OP","10","Select","Select",""],["","00078090438","SIMBRINZA","SUS 1-0.2%","8","Select","Select",""],["","","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","","ASPIRIN","TAB 81MG EC","","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","ALPHAGAN","SOL 0.001","","Select","Select",""],["","71351001312","LACTOBACILLU","PAK ","42","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","28","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","60","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","27","Select","Select",""],["","","BD  PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","","INSULIN"," INSULIN ","100","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","60","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","100","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","LYRICA"," LYRICA ","60","Select","Select",""],["","","LANSOPRAZOLE"," LANSOPRAZOLE ","30","Select","Select",""],["","","KETOROLAC"," KETOROLAC ","10","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","20","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","21","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","28","Select","Select",""],["","","FREESTYLE    KIT SENSOR"," FREESTYLE    KIT SENSOR","28","Select","Select",""],["","","GAVILYTE-G"," GAVILYTE-G ","4000","Select","Select",""],["","","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","","MOXIFLOXACIN","TAB 400MG","","Select","Select",""],["","","COMBIGAN","SOL 0.2\/0.5%","","Select","Select",""],["","","AYR","DRO 0.0065","","Select","Select",""],["","","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","","DEEP","SPR 0.0065","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","PHOS-NAK","POW CONCENTR","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}