{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARQUETTA ANDERSON","gend":1,"add":"5929 BRADFORD DR","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1967-06-08","age":"","mstatus":"","insh":"20059524*01","cliId":"","pno":"757\/774-1052","cno":"757\/774-1052","email":"","ename":"","eno":"","pphy":"FRANK, JANINE M MD","ppno":"","pcpadd":"4124 CHESAPEAKE SQUARE BLVD STE 103","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Chesapeake Square","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/673-8291","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G45.9","Z20.828","Z86.73","I63.00","I67.9","I66.09","G47.33","M46.96","M71.38","E11.9","Z79.84","R39.81","N81.84","NO DATA","M47.896","G81.90","M21.371","R29.898","M65.311","Z68.32","G89.29","M17.0","M46.1","M54.5","Z79.891","E66.09","Z68.30","Z01.812","M25.551","M77.9","Z91.81","M16.11","M70.61","M25.561","M25.562","T82.856A","M19.90","E78.00","Z88.0","Z91.018","Z79.82","Z79.02","Z79.4","Z79.899","I66.02","I69.351","E11.65","G47.30","E66.01","F17.290","F41.9","Z79.1","I10.","Z23.","E55.9","I77.1","K59.00","R63.4","Z12.11","Z11.59","E11.40","M54.41","M62.838","M47.816","M15.9","Z71.6","M79.604","M54.16","I66.01","Z95.1","I69.359","F33.9","R30.0","Z09.","I63.412","E78.5","G62.9","I25.10","F17.210","G51.0","Z60.2","Z88.8","Z83.3","Z82.49","Z82.61","I37.1","I69.328","E11.42","E78.2","R35.0","G89.4","M79.7","R47.81","S32.10XA","V54.27","E08.49","M79.644","R25.2","F32.9","M25.48","Z72.0","Z12.39","K59.01","R63.0","R20.0","M62.81","I63.511","M25.559","M25.552"],"date":["2020-10-26","2020-11-20","2022-10-28","2022-04-07","2022-10-28","2021-10-04","2021-05-12","2021-04-27","2021-05-25","2021-09-20","2021-10-04","2022-11-10","2022-11-10","2022-05-31","2022-11-07","2022-11-07","2022-05-26","2022-05-26","2020-07-23","2020-07-23","2022-03-18","2022-03-07","2022-05-09","2021-09-01","2020-09-15","2020-10-23","2022-05-16","2020-11-20","2021-09-10","2021-01-29","2021-05-25","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-10-04","2021-10-04","2021-09-20","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2022-11-07","2022-04-07","2021-10-04","2022-05-09","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2022-01-07","2022-01-07","2022-01-07","2022-10-24","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-03-07","2022-03-18","2022-03-18","2022-05-16","2020-10-21","2020-10-21","2021-01-29","2021-03-31","2022-03-30","2022-03-30","2022-05-09","2022-05-09","2022-05-09","2020-03-19","2020-10-21","2020-10-21","2020-12-11","2020-10-21","2020-11-04","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-22","2020-11-04","2020-11-04","2020-12-11","2021-03-24","2021-04-05","2021-04-05","2020-10-26","2021-03-31","2021-03-31","2020-03-19","2020-03-19","2020-05-04","2020-06-01","2021-04-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-10-21","2020-10-21","2020-11-09","2020-12-11","2021-03-05"],"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":[["","00406048410","APAP\/CODEINE","TAB 300-30MG","16","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","180","Select","Select",""],["","00597015390","JARDIANCE","TAB 25MG","90","Select","Select",""],["","29300041319","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","64980028105","GLIPIZIDE","TAB 10MG","30","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","3","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","49035065082","EQ","TAB 20MG","40","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00002223680","TRULICITY","INJ 3\/0.5","6","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","57664037713","TRAMADOL","TAB 50MG","60","Select","Select",""],["","00409178269","NALOXONE","INJ 0.4MG\/ML","1","Select","Select",""],["","72205001290","PREGABALIN","CAP 50MG","60","Select","Select",""],["","45802086801","POLYETH","POW 3350 NF","119","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","81131038679","RELION","MIS 32GX4MM","50","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","69238115403","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","00006027754","JANUVIA","TAB 100MG","30","Select","Select",""],["","65162017910","METFORMIN","TAB 750MG ER","60","Select","Select",""],["","98302000105","ALCOHOL","PAD ","100","Select","Select",""],["","00310653004","BYDUREON","INJ 2MG","4","Select","Select",""],["","50228017705","GABAPENTIN","TAB 600MG","120","Select","Select",""],["","12843003520","STOOL","CAP 100MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","00904516580","SENNA","TAB 8.6MG","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","69315090401","LORAZEPAM","TAB 0.5MG","20","Select","Select",""],["","49035089212","NATURAL","TAB 8.6MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","45963043963","CONSTULOSE","SOL 10GM\/15","240","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","00193654621","BAYER","MIS LANCETS","100","Select","Select",""],["","70677003101","SM","DIS 14MG\/24H","28","Select","Select",""],["","00904679489","ASPIRIN","CHW 81MG","90","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":""}]}]}