{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IVETTE FIGUEROA-CRUZ","gend":1,"add":"3051 KINGS ROW CT APT 101","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1971-10-15","age":"","mstatus":"","insh":"20041216*01","cliId":"","pno":"757\/500-1539","cno":"757\/264-8750","email":"","ename":"","eno":"","pphy":"WATSON, NICOLE M NP","ppno":"757\/395-1300","pcpadd":"1975 GLENN MITCHELL DR STE 202","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/226-0247","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I21.19","F14.920","E11.65","F25.0","E78.2","Z21.","F10.20","F11.20","F19.10","E13.69","J18.9","R42.","R07.89","F14.10","I25.119","F31.81","B20.","Z91.14","Z87.891","R07.9","B18.2","F17.200","Z71.89","R52.","N17.9","F41.9","I63.9","F14.20","I25.10","R41.0","R10.84","Z95.5","NO DATA","I47.2","F14.229","F12.10","I10.","E78.5","B19.20","E78.00","F11.21","I95.9","Z91.19","Z83.3","A41.9","J69.0","E87.2","K86.1","E83.42","E11.9","Z79.82","G93.40","F19.21","R45.1","V62.85","F20.9","N89.8","I20.0","Z53.29","Z88.8","G47.9","S89.92XA","S99.912A","M77.8","Z98.61","M94.0","R41.82","Z53.21","I25.2","Z87.898","R11.2","Z20.822","T40.5X1A","F20.3","N39.0","F25.9","Z20.828","V58.89","E11.69","R07.2","F99.","Z68.36","Z86.19","T50.914A","F25.8","R87.613","E11.29","G56.21","J30.1","K76.0","E66.01","R80.9","Z68.41","V62.84","Z62.810","E66.9","F14.21","F25.1","R10.9","N30.00","F31.64","Z11.3","Z79.84","E11.649","F31.9","L29.2","N91.5","Z95.1"],"date":["2020-04-13","2020-04-12","2021-09-16","2021-12-30","2021-10-22","2021-12-05","2021-12-30","2021-12-30","2020-10-05","2020-10-05","2021-11-26","2020-11-19","2021-12-04","2021-11-18","2021-11-18","2021-12-05","2021-12-05","2021-06-22","2021-11-23","2021-12-04","2021-12-05","2021-09-17","2021-09-16","2021-10-13","2021-12-05","2021-11-18","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2020-04-11","2020-04-11","2020-04-11","2021-11-23","2021-11-23","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2021-12-04","2021-12-01","2021-11-23","2021-11-23","2021-11-23","2021-12-04","2021-11-23","2021-12-04","2021-12-03","2021-12-03","2020-04-30","2021-09-16","2020-05-01","2021-05-31","2021-10-29","2021-10-29","2021-10-29","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-12-04","2021-12-04","2021-04-16","2021-10-14","2021-05-31","2021-11-23","2021-11-23","2020-08-02","2020-08-03","2020-08-03","2020-08-02","2020-08-02","2020-08-03","2020-08-03","2021-10-14","2021-10-14","2020-04-15","2021-10-14","2021-11-23","2019-10-21","2019-09-05","2019-10-22","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-10-22","2019-10-22","2019-06-30","2019-05-13","2019-05-13","2019-05-13","2019-05-13","2019-02-22","2019-02-22","2019-05-14","2019-10-22","2019-06-30","2019-06-18","2019-06-18","2019-09-05","2019-09-05","2021-05-31"],"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":[["","00527179001","FLUPHENAZINE","TAB 5MG","30","Select","Select",""],["","00185061505","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","00006027754","JANUVIA","TAB 100MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","5","Select","Select",""],["","16729000201","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","","LISINOPRIL","TAB 5MG","","Select","Select",""],["","23155010410","METFORMIN","TAB 1000MG","60","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","","ASPIRIN","TAB 81MG EC","","Select","Select",""],["","55111016705","OLANZAPINE","TAB 15MG","27","Select","Select",""],["","","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","76385010410","BENZTROPINE","TAB 1MG","60","Select","Select",""],["","00223172101","SODIUM","TAB 650MG","8","Select","Select",""],["","51672670800","CLOTRIMAZOLE","CRE 3 DAY","22","Select","Select",""],["","51672206200","3","CRE 0.02","21","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","61958200201","DESCOVY","TAB 200\/25","30","Select","Select",""],["","51224020650","NALTREXONE","TAB 50MG","30","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","30","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","00143952901","FLUPHENAZ","INJ 25MG\/ML","5","Select","Select",""],["","00093719805","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","VEMLIDY","TAB 25MG","","Select","Select",""],["","","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","65597070118","WELCHOL","TAB 625MG","180","Select","Select",""],["","51660099628","COLESEVELAM","TAB 625MG","84","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","100","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","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":""}]}]}