{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROL STILLMAN","gend":1,"add":"4490 STEVENS DR","city":"CARRSVILLE","state":"VA","zip":23315,"dob":"1963-10-29","age":"","mstatus":"","insh":"20041434*01","cliId":"","pno":"757\/642-7558","cno":"","email":"","ename":"","eno":"","pphy":"Williams, Lindsey","ppno":"757\/983-8650","pcpadd":"2760 Godwin Boulevard Suite 100","pcpcity":"Suffolk","pcpstate":"VA","pcpzip":23315,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine & Walk-In - Suffolk","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/983-8673","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.0","F33.1","F51.01","R07.81","L20.9","M25.512","M50.90","E66.01","M89.8X1","M54.5","E07.9","E11.69","E11.59","I25.118","Z78.0","Z12.39","Z12.11","J44.9","I10.","E78.5","M47.812","M47.816","Z00.00","E11.65","I25.10","F32.9","F41.9","L30.9","L60.0","Z13.820","Z01.818","NO DATA","G47.00","Z12.2","I15.2","Z87.891","R22.1","E55.9","T50.Z95A","M79.602","I11.9","E11.9","K42.9","M25.561","M79.671","Z01.810","Z01.812","R94.31","I25.2","E11.8","M54.12","M54.16","H25.13","F33.41","Z68.36","N30.00","G89.29","R41.3","G47.33","I31.3","J22.","L25.9","N95.9","I25.83","R05.","J02.9","J44.1","Z23.","M79.604","M79.605","R00.1"],"date":["2021-03-29","2021-11-10","2021-01-26","2021-04-14","2020-05-08","2020-05-08","2020-06-24","2021-03-29","2020-06-24","2020-08-02","2020-06-24","2021-12-01","2021-12-01","2021-12-01","2021-07-26","2021-03-29","2021-12-01","2021-12-01","2021-03-29","2021-12-01","2021-02-23","2021-02-23","2021-07-26","2021-10-20","2021-11-24","2021-07-26","2021-12-01","2021-07-26","2021-07-26","2021-07-26","2021-11-24","2021-12-01","2021-12-01","2021-10-20","2021-12-01","2020-08-02","2020-09-04","2020-09-04","2021-05-25","2021-05-25","2021-11-24","2021-12-01","2021-08-24","2020-01-10","2020-01-10","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2019-04-30","2019-12-02","2019-12-02","2019-08-27","2019-12-04","2019-12-04","2019-09-02","2019-09-02","2019-09-05","2019-09-05","2019-11-11","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-11-04","2019-06-27","2019-06-27","2019-11-04","2019-08-02","2019-08-02","2019-11-11"],"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":[["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","45","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59651026905","GLIPIZIDE","TAB 5MG","90","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00536100836","ASPIRIN","CHW 81MG","100","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00363021807","ASPIRIN-81","CHW 81MG","90","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","60","Select","Select",""],["","00378718605","METFORMIN","TAB 850MG","180","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","51862094205","DIAZEPAM","TAB 5MG","2","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":""}]}]}