{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLIE   M BELTON","gend":1,"add":"533 ROLAND DR","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1961-02-02","age":"","mstatus":"","insh":"20068452*01","cliId":"","pno":"757\/650-9159","cno":"757\/650-9159","email":"","ename":"","eno":"","pphy":"BETZ, MICHELLE K DO","ppno":"757\/252-9140","pcpadd":"STE 202 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Neurology Specialists - Princess Anne","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7752","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.816","G89.29","M54.41","M54.2","M54.12","M47.812","Z86.59","Z87.820","R20.2","R56.9","R41.89","R26.9","R26.89","M50.30","Z20.828","R50.9","J01.90","G44.319","M25.512","R42.","F33.1","F41.1","S10.96XA","Z71.9","R41.841","R11.2","R10.9","K59.00","K21.9","M51.36","I34.1","M19.90","Z79.899","Z87.891","Z88.8","Z91.011","H10.32","S63.501A","S63.91XA","B02.9","R05.","M54.5","M79.642","R07.9","Z82.61","R06.02","R07.89","L25.5","V58.89","M51.37","M54.16","M47.817","M51.26","M79.2","NO DATA","M62.838","E66.9","M79.643"],"date":["2021-08-23","2022-10-03","2022-10-03","2020-11-25","2022-11-23","2022-10-20","2020-12-10","2020-12-10","2020-12-10","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2022-10-20","2021-07-26","2020-11-05","2020-11-05","2020-11-25","2020-11-25","2020-11-25","2021-12-17","2021-12-17","2021-10-04","2021-10-04","2022-04-04","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2021-08-23","2021-08-23","2022-05-31","2021-08-23","2022-05-31","2022-05-31","2022-05-31","2020-09-25","2020-10-27","2020-10-27","2020-12-31","2021-07-26","2021-08-23","2022-05-31","2022-05-31","2022-05-31","2022-05-31","2022-05-31","2022-08-01","2020-11-23","2020-08-21","2020-08-21","2020-08-21","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2022-04-20"],"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":[["","00115180401","HYDROXYZ","CAP 50MG","90","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","21922002505","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","30","Select","Select",""],["","00527293441","PREDNISONE","TAB 20MG","28","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","8","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","70156010401","HYOSCYAMINE","TAB 0.125MG","120","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00135019902","CITRUCEL","TAB 500MG","60","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","30","Select","Select",""],["","00536105227","PEG3350","POW ","510","Select","Select",""],["","68180011216","LEVETIRACETA","TAB 250MG","60","Select","Select",""],["","00378811745","DOXEPIN","CRE 0.05","45","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","17478062235","SOD","OIN 5% OP","4","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","60","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","60","Select","Select",""],["","00527530270","BPM-PSE-DM","SYP 2-30-10","600","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","50","Select","Select",""],["","58657045001","PHENAZOPYRID","TAB 100MG","21","Select","Select",""],["","00574110404","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00143211250","DOXYCYCL","TAB 100MG","42","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","31722070590","VALACYCLOVIR","TAB 1GM","30","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":""}]}]}