{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE   L BROOKS","gend":1,"add":"4177 STARWOOD ARCH APT 201","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1981-04-03","age":"","mstatus":"","insh":"2083321*01","cliId":"","pno":"757\/995-3422","cno":"","email":"","ename":"","eno":"","pphy":"LAW, KATHERINE P MD","ppno":"757\/413-7600","pcpadd":"5320 PROVIDENCE #301","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-7656","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.0","G43.019","N83.202","R10.32","N83.512","N30.01","Z90.721","F14.90","G58.8","L03.119","L02.419","I77.71","N10.","H43.11","S01.512A","D50.9","R53.82","K21.9","R74.8","R63.1","N30.91","R10.2","I63.9","I72.0","L03.319","R59.0","N64.4","R10.84","R11.2","Z90.710","M25.511","G43.909","K58.9","I10.","I69.351","G90.2","F31.9","G43.109","F41.9","F43.10","M19.041","F60.3","E78.5","F14.10","F17.210","Z79.82","Z79.02","Z79.51","G89.18","G47.01","J30.2","N83.209","E11.9","Z87.891","Z88.8","Z88.2","Z88.5","Z88.0","Z88.1","L82.0","L73.9","I16.1","R29.90","R51.9","I63.541","G81.91","R29.705","J32.9","B96.89","I65.01","G47.00","G40.909","G43.011","E78.2","F17.200","B00.9","R10.9","R31.9","F31.10","R68.84","L02.91","Z86.73","E61.1","G81.90","N93.9","N39.0","N85.2","N92.0","N73.6","G43.709","Z20.828","I67.83","T40.5X5S","F51.04","K59.09","R39.15","R35.0","R60.0","Z90.79","Z86.14","Z87.440","G43.719","B02.9","Z87.19","Z82.49","Z91.048","Z91.012","NO DATA","R30.0","N83.519","F31.4","R03.0","R73.9","Z09.","R31.0","Z87.442","D62.","K59.00","B34.9","B00.1","N30.00","Z91.5","Z62.810","Z91.410","K58.2","T81.49XD","N70.92","I51.7","R50.9","R11.0","R10.31","Z87.11","Z87.448","Z98.890","R20.0","R20.2","L72.9","Z80.9","Z79.899","Z80.1","Z80.0","Z80.3","T78.40XS","R05.","J06.9","T14.8XXA","L76.82","I63.59","F31.70","Z72.0","G43.809","F43.20","S93.401A","R51.","S01.511A","B02.8","Z32.02","M54.9","L25.9","N80.9","M54.5","L30.9","Z71.6","M25.531","J01.00","Z30.46","J02.8","B97.89","B35.4","R21.","N94.89","G89.29","Z20.822","L50.9","L51.1","U07.1","L30.4","F33.9","G62.9","K58.1","Z86.79","Z45.09","M20.11","M20.12","M79.671","M24.573","R52.","M79.672","R14.0","N83.01","N83.291","Z87.42","E78.00","Z91.09","K50.90","Z86.19","R20.8","N83.9","J20.9"],"date":["2020-10-08","2021-07-28","2020-08-26","2021-12-02","2020-08-28","2020-08-27","2022-10-10","2021-04-20","2022-02-07","2021-02-10","2021-02-10","2022-02-21","2021-04-30","2021-11-19","2021-08-07","2021-09-21","2021-09-30","2022-09-28","2021-09-30","2021-09-30","2021-10-28","2022-08-30","2022-02-10","2021-12-19","2020-05-27","2020-05-27","2020-05-27","2021-06-24","2020-08-25","2021-10-28","2020-09-08","2022-09-28","2020-09-08","2022-09-28","2021-05-06","2022-02-21","2021-05-06","2021-05-06","2022-02-21","2021-05-06","2021-05-06","2021-08-26","2021-05-06","2021-05-06","2021-05-06","2022-08-30","2022-02-21","2021-05-06","2021-06-07","2021-07-08","2021-10-21","2021-09-16","2022-08-30","2022-01-26","2022-02-21","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2020-07-15","2022-06-09","2021-04-26","2021-04-16","2021-04-15","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-10-28","2021-04-17","2022-09-28","2021-05-06","2021-05-06","2021-08-29","2021-08-29","2022-09-28","2020-10-08","2020-10-08","2022-09-28","2021-05-21","2021-08-09","2021-09-16","2021-09-16","2020-01-22","2020-01-22","2022-08-30","2020-02-17","2020-07-20","2021-04-23","2021-04-23","2021-10-21","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2022-08-30","2022-08-30","2020-08-26","2020-02-21","2020-05-13","2020-02-25","2021-10-28","2022-08-30","2020-02-25","2020-02-25","2020-07-28","2020-08-26","2020-09-10","2021-02-11","2021-02-11","2021-04-26","2021-11-11","2021-11-11","2021-12-02","2021-12-02","2020-04-01","2020-04-01","2020-08-25","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2021-04-14","2021-06-24","2021-06-24","2021-08-29","2021-09-16","2021-09-16","2021-10-28","2020-06-16","2022-06-24","2020-07-15","2020-08-26","2022-08-30","2020-08-26","2020-08-26","2020-08-26","2020-05-13","2020-05-13","2020-07-08","2020-09-09","2020-09-09","2021-04-15","2021-08-26","2019-11-19","2019-04-28","2019-07-11","2019-07-25","2019-09-30","2019-08-13","2019-08-26","2019-10-28","2019-09-26","2019-05-23","2019-09-25","2019-09-25","2019-09-25","2019-06-18","2019-01-09","2019-04-07","2019-10-08","2019-10-27","2019-10-27","2019-11-11","2022-02-17","2022-08-30","2022-08-30","2022-11-05","2022-01-26","2022-02-17","2022-02-17","2022-06-09","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-02-10","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2022-06-27","2022-08-30","2022-08-30","2022-08-30","2022-02-21","2022-02-21","2022-01-26","2022-01-26","2022-01-26","2022-08-30","2022-11-05"],"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":{"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":[["","00591544310","PREDNISONE","TAB 20MG","21","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00378039001","NIFEDIPINE","TAB 90MG ER","30","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","15","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00115166103","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","","VRAYLAR","CAP 1.5MG","","Select","Select",""],["","00781714483","ESTRADIOL","DIS 0.05MG","8","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","UBRELVY","TAB 50MG","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","00093506110","HYDROXYZ","TAB 25MG","28","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","00093321930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","","BENZOYL","LIQ 5% WASH","","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","10","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","20","Select","Select",""],["","","CLINDAMYCIN","LOT 10MG\/ML","","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00536110788","NICOTINE","DIS 14MG\/24H","14","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","","EMGALITY","INJ 120MG\/ML","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","00536117201","ACETAMIN","TAB 500MG","30","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","946","Select","Select",""],["","00006003330","BELSOMRA","TAB 10MG","30","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","51991036378","RIZATRIPTAN","TAB 10MG ODT","12","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","ZOSTRIX","CRE 0.00033","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","","ANECREAM","CRE 0.04","","Select","Select",""],["","","REXULTI","TAB 1MG","","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","","FLUBLOK","INJ 2020-21","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","28","Select","Select",""],["","00052027303","NUVARING","MIS ","1","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","18","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA BL","100","Select","Select",""],["","00904615760","VITAMIN","TAB 2000UNIT","60","Select","Select",""],["","59779043267","NASAL","TAB 30MG","48","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00143178701","BUT\/APAP\/CAF","TAB ","12","Select","Select",""],["","65862096801","ESZOPICLONE","TAB 2MG","60","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","69918030130","TRANEX","TAB 650MG","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":{"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":""}]}]}