{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   G LOAR","gend":1,"add":"2139 MADISON AVE","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1961-04-20","age":"","mstatus":"","insh":"20044542*01","cliId":"","pno":"757\/238-0494","cno":"","email":"","ename":"","eno":"","pphy":"JACKSON, PAMELA E MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9802","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.1","R53.83","I63.9","E11.9","Z79.4","I10.","N39.0","R07.81","R07.9","G89.29","M54.9","J44.9","F41.8","Z72.0","I69.393","R26.89","R29.898","R51.9","Z20.822","J45.20","M79.7","E78.2","M54.41","N39.46","Z12.11","Z12.31","M54.42","M79.605","R20.0","NO DATA","R26.9","I69.30","R52.","G83.10","R41.89","E11.65","E55.9","E78.1","E11.69","E16.2","J41.0","R21.","D17.1","F31.11","E66.01","Z11.59","E11.42","F17.210","Z88.6","Z88.5","Z91.040","Z88.8","Z91.048","I63.521","R29.704","I63.511","G81.94","I67.2","R26.2","F41.0","F17.200","M51.16","K21.9","E11.41","F41.9","I69.354","G47.33","R32.","C64.9","G62.89","R19.7","G47.00","G25.81","B99.9","I69.344","I69.318","G89.4","F32.9","F43.10","Z63.4","Z85.528","R41.9","G62.9","R20.9","R74.8","Z76.89","Z86.39","F13.20","F11.20","R73.9","G46.3","N39.45","F33.2","N82.3","R27.8","M25.511","N30.00","M51.36","F01.50","K27.9","Z87.891"],"date":["2021-11-28","2021-11-28","2022-06-22","2022-10-23","2021-11-30","2022-06-22","2021-12-05","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2022-03-28","2022-03-28","2021-11-26","2021-11-26","2021-09-16","2022-01-19","2022-06-22","2021-09-16","2022-10-23","2021-09-16","2021-09-16","2021-11-24","2021-11-27","2021-11-27","2022-01-19","2022-10-23","2021-12-21","2021-12-12","2021-12-19","2021-12-19","2022-01-19","2022-01-19","2021-12-12","2022-06-22","2021-09-02","2022-06-22","2021-09-02","2022-06-22","2021-09-02","2022-06-22","2021-09-02","2021-11-24","2022-01-19","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2022-03-28","2021-11-27","2021-11-27","2022-06-22","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2022-01-19","2021-11-27","2022-01-19","2022-01-19","2022-01-19","2021-12-19","2021-12-19","2021-11-24","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-11-30","2021-11-30","2022-01-19","2022-01-19","2022-01-19","2021-11-30","2021-11-30","2021-12-21","2019-11-11","2019-11-11","2019-08-19","2019-08-19","2022-06-22","2019-08-19","2019-08-19","2019-08-19","2022-10-23","2022-10-23","2022-06-22","2022-06-22","2022-03-28","2022-03-28","2022-01-20","2022-01-19","2022-01-19","2022-01-19","2022-01-19"],"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":[["","29300039805","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","68180063809","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","00536589453","NICOTINE","DIS 7MG\/24HR","7","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","69238106501","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","43547035210","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","69315031228","PROCTO-MED","CRE HC 2.5%","28","Select","Select",""],["","70436001004","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","57664037708","TRAMADOL","TAB 50MG","21","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00093206406","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","60505014100","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00591551305","CARISOPRODOL","TAB 350MG","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","43547040650","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","68462024805","RANITIDINE","TAB 150MG","60","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68462047101","POT  CL MICRO","TAB 10MEQ ER","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":{"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":""}]}]}