{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOMINIQUE   I FREEMAN","gend":0,"add":"316 W 28TH ST APT A","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1990-05-26","age":"","mstatus":"","insh":"20042628*01","cliId":"","pno":"757\/632-2698","cno":"","email":"","ename":"","eno":"","pphy":"TALBOT, ROGER PA","ppno":"757\/261-5999","pcpadd":"850 KEMPSVILLE RD STE 200B","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Walk In Care Kempsville","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/466-0321","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","N25.81","N18.6","Z99.2","V58.89","T82.858A","T82.898A","T82.838A","I87.1","I10.","E78.2","D63.1","S76.119A","Z74.09","I12.0","D50.9","E03.9","Z86.711","Z87.01","Z87.891","M25.569","M25.461","M25.462","S76.111A","S76.112A","K59.00","K56.41","Z86.79","S73.119A","K56.7","E89.0","E66.9","M62.838","I95.89","N25.89","NO DATA","Z79.899","Z79.890","Z91.018","Z85.850","I31.3","I70.0","M62.81","R26.9","R29.898","K59.01","M25.561","M25.562","G89.29","R53.1","S30.0XXA","S83.412A","S80.12XA","S70.02XA","J02.9","J30.1","M25.551","R68.89","R26.2","R52.","R05.","I13.2","I50.32","Z20.822","N52.9","K21.9","E78.5","E83.39","E87.6","Z91.15","Z98.890","W19.XXXA","A41.9","J10.1","R65.21","M54.5","R10.30","M79.671","M79.672","J03.90","J20.9","I50.33","I95.9","T82.590A","I36.1","J90.","N26.9","Z90.5","N32.89","Z91.14","R11.10","R19.7","R10.33","Z91.19","E89.2","R10.9"],"date":["2020-11-13","2021-12-01","2021-12-01","2021-12-01","2021-08-18","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2021-05-31","2021-07-26","2021-07-26","2021-05-31","2021-05-31","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-05-22","2021-05-19","2021-05-19","2021-05-24","2021-05-24","2021-06-06","2021-06-06","2021-06-06","2021-05-22","2021-05-23","2021-05-23","2021-05-23","2021-05-27","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-26","2021-05-26","2021-05-27","2021-10-06","2021-05-27","2021-05-27","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-11-13","2020-11-13","2021-11-12","2020-01-09","2021-05-15","2021-06-22","2020-04-08","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-06-22","2021-06-22","2019-12-12","2019-12-14","2019-12-12","2019-07-15","2019-06-03","2019-06-03","2019-06-03","2019-06-26","2019-10-09","2019-06-26","2019-12-14","2019-12-13","2019-04-19","2019-04-19","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-17","2019-12-17","2019-12-17","2019-12-17","2019-12-09","2019-12-17"],"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":[["","42858010201","OXYCOD\/APAP","TAB 5-325MG","18","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","00378181977","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","20","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","70436000904","CINACALCET","TAB 90MG","30","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","240","Select","Select",""],["","00603107558","CHERATUSSIN","SYP AC","240","Select","Select",""],["","","CALC","CAP 667MG","","Select","Select",""],["","55513007530","SENSIPAR","TAB 90MG","30","Select","Select",""],["","","ALLERGY","SPR 50MCG","","Select","Select",""],["","00245021311","MIDODRINE","TAB 10MG","270","Select","Select",""],["","","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","","GG\/CODEINE","SOL 100-10\/5","","Select","Select",""],["","","GUAIFENESIN","SYP 100-10\/5","","Select","Select",""],["","10542007010","DIALYVITE","TAB 800","30","Select","Select",""],["","60258016001","RENA-VITE","TAB ","30","Select","Select",""],["","65162005827","SEVELAMER","TAB 800MG","360","Select","Select",""],["","58468013001","RENVELA","TAB 800MG","360","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","20","Select","Select",""],["","00536730001","NEPHRO-VITE","TAB ","30","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","16714039102","CEFDINIR","CAP 300MG","20","Select","Select",""],["","62542030117","HYD","SUS 10-8\/5ML","100","Select","Select",""],["","50383008716","GUAIATUSS","SYP 100-10\/5","120","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":""}]}]}