{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATASHA   L CITIZEN","gend":1,"add":"223 CLAY ST","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1975-09-17","age":"","mstatus":"","insh":"20057252*01","cliId":"","pno":"757\/842-8232","cno":"757\/842-8232","email":"","ename":"","eno":"","pphy":"MORRISON, WILLIAM PA","ppno":"757\/983-8600","pcpadd":"114 N MAIN ST STE 200","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Downtown Suffolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-3012","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.2","M79.609","U07.1","R78.81","J96.01","NO DATA","B95.7","E61.1","Z79.01","Z86.718","R42.","Z01.419","E66.9","J40.","R19.5","Z12.31","K63.5","K57.30","F32.2","F43.12","F41.1","G47.33","D64.89","D75.89","R71.8","N89.9","R07.89","F32.9","H01.001","R06.00","Z86.16","Z86.711","I82.532","M75.31","Z68.43","Z91.14","Z91.09","M25.511","G47.30","R05.9","U09.9","R05.","I82.409","N17.9","I82.432","I82.442","A08.39","E86.0","E66.01","Z79.899","Z88.5","Z88.8","Z90.710","I82.4Y2","J31.0","R10.2","B37.3","N76.1","J20.9","L03.113","R30.0","R09.02","R11.2","R19.7","R06.02","M79.662","M79.89","F33.1","J45.30","N76.0","L70.0","L81.0","D12.5","I82.4Y9","A60.9","J02.9","J12.89"],"date":["2021-10-05","2022-01-16","2022-01-20","2022-01-20","2022-01-20","2022-09-20","2022-01-19","2022-09-28","2022-09-28","2022-09-28","2022-03-24","2021-01-27","2022-08-07","2021-01-28","2021-05-12","2021-05-04","2021-05-12","2021-05-12","2021-08-25","2021-08-25","2021-08-25","2022-09-21","2020-01-14","2020-01-14","2020-07-14","2021-01-20","2021-05-04","2021-05-04","2021-06-24","2022-09-21","2022-09-21","2022-09-21","2022-08-07","2022-08-07","2022-08-07","2022-08-07","2022-08-07","2022-08-07","2021-08-17","2022-02-15","2022-03-24","2021-09-16","2022-08-07","2022-01-16","2022-01-16","2022-01-16","2022-01-16","2022-01-16","2022-06-09","2022-01-16","2022-01-16","2022-01-16","2022-01-16","2022-01-20","2020-01-07","2020-02-20","2020-02-20","2020-02-20","2021-09-28","2021-09-28","2020-05-01","2022-02-15","2022-01-16","2022-01-16","2022-02-15","2022-08-07","2022-08-07","2022-06-09","2022-06-09","2020-02-13","2020-03-17","2020-03-17","2021-05-12","2022-01-16","2020-01-30","2022-01-06","2022-01-16"],"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":[]},{"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":[["","00054418625","DEXAMETHASON","TAB 6MG","6","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","27808008602","HYD","SUS 10-8\/5ML","50","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","120","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","20","Select","Select",""],["","00173071720","ADVAIR","AER 230\/21","12","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","49348001734","SM","SYP 100-10\/5","118","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","120","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","67405060301","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68462015305","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","59267102501","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","15","Select","Select",""],["","50428038612","ACETAMINOPHN","TAB 500MG","20","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","8","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","50383094230","AZELASTINE","SPR 0.0015","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","49884072703","DOXYCYC","CAP 100MG","20","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","200","Select","Select",""],["","00378668877","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","00378875006","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","45802056202","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","45802050703","CLINDAMY\/BEN","GEL 1-5%","70","Select","Select",""],["","00591042405","TRIAMT\/HCTZ","TAB 37.5-25","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00363040321","WAL-DRAM","TAB 25MG","30","Select","Select",""],["","13107006101","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","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":""}]}]}