{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EARLISA   D FLUELLEN","gend":1,"add":"9 MAUME CIR","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1975-11-15","age":"","mstatus":"","insh":"20069530*01","cliId":"","pno":"757-776-1735","cno":"757\/355-7469","email":"","ename":"","eno":"","pphy":"GLAVE, KRISTLE M NP","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Peninsula Towne","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/827-9978","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F70.","A41.9","F31.31","F31.9","K57.92","N30.01","F31.32","E66.01","E11.9","K21.9","R06.02","B37.2","N89.8","NO DATA","J45.40","E55.9","E78.00","R73.03","F32.2","F31.70","F90.2","N94.89","R03.0","F33.1","F90.0","F71.","N76.0","R11.2","R10.84","K57.32","R65.20","R19.7","Z80.0","Z82.49","Z81.8","Z87.891","Z91.14","Z79.899","Z68.34","R65.11","K57.00","Z00.00","Z01.419","E78.5","E78.2","E78.6","D64.9","K21.00","M25.50","N39.0","F10.20","R35.8","Z68.41","Z68.36","N95.8","K59.00","F60.3","Z11.3","F12.10","N94.9","R16.1","R93.89","Z68.35","I10.","Z12.39","Z12.11","R73.01","Z12.4","Z76.89","Z12.31"],"date":["2022-10-26","2021-07-02","2021-11-02","2022-11-07","2021-06-29","2021-06-29","2021-08-21","2022-05-16","2021-02-23","2021-06-29","2021-02-23","2021-07-20","2022-03-09","2022-10-12","2022-01-20","2022-10-12","2022-10-12","2022-05-16","2022-05-16","2022-05-16","2021-04-15","2021-04-15","2021-04-15","2021-08-21","2021-08-21","2021-08-21","2020-10-18","2020-10-18","2020-10-18","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-01-20","2022-03-09","2021-07-20","2022-10-12","2022-10-12","2022-10-12","2021-07-20","2022-05-16","2021-07-20","2021-12-20","2020-11-24","2020-11-24","2021-04-15","2021-04-15","2022-01-20","2022-05-04","2022-05-03","2022-02-14","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-03-09","2022-03-09","2022-03-09"],"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":[["","60505317007","OMEGA-3-ACID","CAP 1GM","180","Select","Select",""],["","69618000901","VITAMIN","CAP 2000UNIT","68","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","TOPIRAMATE","TAB 100MG","","Select","Select",""],["","","FLUOXETINE","CAP 40MG","","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","270","Select","Select",""],["","00781540292","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","31604002673","D3","TAB 2000UNIT","60","Select","Select",""],["","51079030630","POLYETH","POW 3350 NF","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","00904693176","PEG","POW ","30","Select","Select",""],["","","WIXELA","AER 250\/50","","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","69315030660","NYSTATIN","POW 100000","60","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","6","Select","Select",""],["","00832046560","NYAMYC","POW 100000","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00168025815","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","69618001001","ACETAMIN","TAB 325MG","30","Select","Select",""],["","00536132701","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","QUETIAPINE","TAB 100MG","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","ALLOPURINOL","TAB 100MG","","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":""}]}]}