{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KARIN THOMAS","gend":1,"add":"201 PADDINGTON PL APT 101","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1963-09-29","age":"","mstatus":"","insh":"20059288*01","cliId":"","pno":"347\/825-4425","cno":"","email":"","ename":"","eno":"","pphy":"GEORGE, DYLAN M NP","ppno":"757\/726-5000","pcpadd":"200 EATON ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23669","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Old Hampton","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/726-5001","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I73.9","Z48.812","Z47.81","E11.51","I10.","E78.00","H54.7","Z79.4","Z79.2","Z79.82","Z79.02","Z91.81","Z95.828","Z89.421","I70.90","E11.42","E11.65","E11.59","M54.5","M47.816","E11.69","G89.29","E78.5","L03.114","L30.9","I25.118","I87.319","L97.909","H25.11","M54.42","R07.89","M54.41","L97.512","G62.9","S81.811S","I25.119","I51.9","E11.36","L81.9","R20.9","E11.43","M62.830","I25.110","E11.52","I70.261","L97.511","I70.235","B96.20","Z20.828","R26.89","I15.2","I25.2","F17.210","Z95.1","Z83.3","Z82.49","Z80.9","M79.661","H26.9","M79.651","R03.0","R22.41","M79.674","L03.818","I96.","M79.604","Z01.818","Z01.810","I25.10","E11.9","H25.13","H25.12","Z74.09","I70.203","R20.8","M86.9","E11.49","M20.41","Z09."],"date":["2021-08-26","2021-03-23","2021-03-23","2021-03-23","2021-12-08","2021-03-23","2021-03-23","2021-07-20","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-08-26","2021-07-13","2021-07-20","2021-04-02","2021-07-13","2021-07-13","2021-04-02","2021-07-13","2021-04-02","2021-07-20","2021-07-30","2021-07-20","2021-07-20","2021-07-20","2021-12-08","2021-05-20","2020-01-17","2021-05-20","2020-11-02","2021-02-11","2020-12-21","2021-05-11","2021-05-11","2021-12-08","2020-01-17","2020-01-17","2020-01-15","2020-01-15","2020-10-12","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-23","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2021-12-08","2020-07-01","2020-07-01","2020-07-07","2020-07-07","2020-07-07","2020-11-02","2020-07-01","2020-07-09","2020-10-26","2020-10-26","2021-10-13","2021-10-13","2021-10-13","2021-04-22","2020-01-17","2020-01-17","2020-11-02","2021-02-11","2021-02-11","2021-11-10"],"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":[["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","45963067711","METOPROL","TAB 100MG ER","30","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","27","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","39","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","45","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","42806055212","OMEGA-3-ACID","CAP 1GM","180","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","50","Select","Select",""],["","00363041414","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","51672404003","ENALAPRIL","TAB 20MG","90","Select","Select",""],["","11917020698","BP","MIS AUTO ARM","1","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","62175011937","ISOSORB","TAB 60MG ER","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","270","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","68682029915","LOTEPREDNOL","SUS 0.005","15","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","10","Select","Select",""],["","55111012405","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","47469000312","ALPHA","CAP 300MG","60","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","24208029905","LOTEMAX","SUS 0.005","5","Select","Select",""],["","31604002715","FISH","CAP 1000MG","180","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","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":""}]}]}