{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"INDIA OSOUNA","gend":1,"add":"100 AERO CIR APT 307","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1976-03-06","age":"","mstatus":"","insh":"20040324*01","cliId":"","pno":"757\/570-9843","cno":"","email":"","ename":"","eno":"","pphy":"HATCH, EMMA K PA","ppno":"757\/594-1850","pcpadd":"SUITE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9223","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","Z01.419","J30.89","R51.9","G44.89","E66.3","R13.10","K21.9","K59.00","Z85.850","M79.671","M79.672","R26.9","R53.1","I10.","E78.5","M25.512","M25.511","M54.2","L91.0","L70.0","L81.9","Z71.9","M25.50","R52.","M43.07","E55.9","M54.5","M17.0","G89.29","NO DATA","H16.223","J30.81","J30.1","F12.129","T50.905A","N89.8","M21.70","M79.2","M72.2","M24.572","M24.571","Z47.89","Z91.018","Z01.42","M25.811","M25.812","M79.644","T78.40XA","L50.9","S46.011A","R09.81","R07.0","J06.9","R07.89","K31.89","Z12.39","Z12.4","Z11.3","J01.81","J34.0","J30.2","R09.82","M25.521","M25.522","M17.11","M17.12","R56.9","R06.7","V58.89","Z20.828","L30.0","D23.9","Z00.00","E78.2","F41.8","M35.3","M19.011","M75.41","Z87.39","M41.85","M54.6","N93.8","D80.8","J01.41","M35.00","R51.","J02.9","R05.","M47.812","M47.814","Z98.1","M79.7","K59.09","R10.9","J30.5","Z20.822","M16.11","M25.552","Z96.642","M61.58","J30.9","R29.818","C73.","Z98.890","E04.1","F31.62","F33.1","R60.0","J34.3","Z23.","R20.0","Z47.1","M54.12","M54.16","E89.0","R53.82","Z76.89","J34.2","M16.12","Z00.6","R26.89","Z51.81","Z79.01","K30.","K22.2","Z01.810","M54.9","M41.9","M62.830","S73.192A","M16.0","Z91.410","M16.32","D62.","G43.909","Z86.718","G58.8","K58.9","Z80.8","Z82.49","Z90.710","Z91.040","F41.9","M75.42","M19.012","M61.9","L02.225","E03.9","R89.5","Q60.5","Q60.2","G89.18","R87.810","R63.4","R13.14","G47.00","F43.10","F51.02","M47.816","G43.001","G44.209"],"date":["2021-04-26","2021-11-12","2021-02-01","2021-12-13","2020-11-24","2021-04-23","2021-04-29","2021-05-05","2021-04-23","2021-04-23","2021-12-07","2021-12-07","2021-07-27","2021-09-09","2021-08-31","2021-07-27","2021-09-09","2021-09-09","2021-09-09","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2021-10-13","2021-12-08","2021-12-08","2020-04-21","2021-01-14","2020-05-20","2020-05-20","2021-03-03","2021-12-07","2021-12-13","2021-12-07","2021-12-07","2021-12-07","2020-02-18","2020-03-05","2020-04-15","2021-10-12","2021-10-12","2020-02-18","2020-07-01","2020-10-26","2020-10-06","2021-11-16","2021-04-13","2021-04-13","2021-04-13","2021-04-29","2021-11-12","2021-11-12","2021-11-12","2021-11-16","2021-11-16","2021-11-29","2021-11-16","2020-03-13","2020-03-13","2020-05-11","2020-05-11","2020-05-20","2020-06-04","2020-06-04","2021-09-17","2021-04-27","2021-04-27","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-07","2021-05-07","2021-05-07","2021-10-13","2021-10-13","2021-11-08","2021-12-13","2021-11-29","2021-12-13","2020-09-14","2020-04-16","2020-02-10","2020-05-11","2020-05-11","2021-10-15","2020-05-11","2020-07-23","2020-07-23","2020-07-23","2021-09-27","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2020-04-06","2020-05-21","2021-11-17","2021-03-16","2021-11-17","2021-05-14","2021-05-14","2021-01-28","2021-02-01","2021-03-25","2021-05-20","2021-06-11","2021-06-11","2021-06-11","2021-11-17","2021-11-17","2021-11-17","2019-03-27","2019-06-10","2019-06-10","2019-07-10","2019-07-10","2019-07-10","2019-03-07","2019-03-07","2019-03-15","2019-09-25","2019-09-25","2019-09-25","2019-05-08","2019-05-16","2019-02-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2019-12-11","2019-12-11","2019-12-05","2019-01-03","2019-01-25","2019-10-02","2019-12-10","2019-12-10","2019-12-11","2019-08-23","2019-09-26","2019-01-31","2019-02-28","2019-02-28","2019-02-28","2019-02-28","2019-03-20","2019-03-20"],"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":[["","","AZELASTINE","SPR 0.0015","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","Select","Select",""],["","00591336905","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","00472178310","DICLOFENAC","GEL 0.03","200","Select","Select",""],["","45802056202","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","45802005536","TRIAMCINOLON","OIN 0.001","80","Select","Select",""],["","43199001101","HYOSCYAMINE","SUB 0.125MG","20","Select","Select",""],["","64679096401","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","00363033355","ARTHRTS","TAB 650MG","100","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","31722088290","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","00904671960","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","90","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00781324664","ENOXAPARIN","INJ 40\/0.4ML","3","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","42","Select","Select",""],["","00713052612","PROMETHEGAN","SUP 25MG","6","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","69367017401","HYDROQUINONE","CRE 0.04","28","Select","Select",""],["","06000053766","CERAVE","CRE MOISTURI","453","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","00378821293","ERYTHROMYCIN","GEL 0.02","60","Select","Select",""],["","00023079815","REFRESH","DRO 0.5% OP","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","11917013938","VITAMIN","TAB 500MG","60","Select","Select",""],["","68180046701","LOVASTATIN","TAB 10MG","30","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","70756020111","AMITRIPTYLIN","TAB 10MG","60","Select","Select",""],["","","BUDESONIDE","SUS 0.5MG\/2","","Select","Select",""],["","","AFRIN","SPR 0.0005","","Select","Select",""],["","60631004030","EDARBI","TAB 40MG","30","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","","LIDO\/PRILOCN","CRE 2.5-2.5%","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","","METRONIDAZOL","GEL 0.75%VAG","","Select","Select",""],["","00363033601","ACETAMIN","TAB 650MG","100","Select","Select",""],["","00904198251","MAPAP","TAB 325MG","42","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","51672300803","LIDOCAINE","OIN 0.05","50","Select","Select",""],["","43547038003","DULOXETINE","CAP 30MG","30","Select","Select",""],["","68382009705","PAROXETINE","TAB 10MG","30","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00363011222","WAL-PHED","TAB 30MG","144","Select","Select",""],["","68462024805","RANITIDINE","TAB 150MG","60","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","68585000801","ZINC","CAP 220MG","30","Select","Select",""],["","00363007302","ANTACID","SUS ","355","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","42","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","30","Select","Select",""],["","62175044215","POLYETH","POW 3350 NF","255","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","42","Select","Select",""],["","11917002642","SALINE","SPR 0.0065","44","Select","Select",""],["","50580054548","SUDAFED","TAB 30MG","180","Select","Select",""],["","65862020199","LOSARTAN","TAB 25MG","30","Select","Select",""],["","00081086524","SUDAFD","TAB DECONGES","168","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","40","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","30","Select","Select",""],["","63736012301","VITRON-C","TAB 65-125","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","15","Select","Select",""],["","67618010110","COLACE","CAP 100MG","60","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","00536194583","RULOX","SUS ","105","Select","Select",""],["","00904645760","DOK","CAP 100MG","60","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":""}]}]}