{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ESSENCE   L BROWN","gend":1,"add":"1720 ROWLOCK ROAD","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1993-10-21","age":"","mstatus":"","insh":"2174692*01","cliId":"","pno":"757\/525-5811","cno":"757\/525-5811","email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":"757\/594-1850","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-1841","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.36","M54.16","F41.1","F31.9","S99.912A","S52.124A","S52.134A","F17.210","Z88.6","Z91.040","Z88.8","Z91.018","M25.521","M54.32","G47.9","F31.61","M47.26","M41.26","Z00.00","E01.0","F41.9","NO DATA","W19.XXXA","M54.42","H92.01","S52.601A","M25.572","M79.601","I10.","H53.8","G89.29","M51.16","J06.9","S52.121A","S52.209A","S50.11XA","S52.101A","S52.041A","Y92.29","Y93.89","S39.012A"],"date":["2022-01-26","2021-01-22","2021-05-07","2021-06-23","2022-08-28","2022-08-29","2022-08-28","2022-08-29","2022-08-28","2022-08-28","2022-08-28","2022-08-28","2022-08-28","2020-11-12","2020-11-12","2022-01-03","2020-12-02","2021-01-25","2021-05-18","2021-05-18","2021-05-18","2022-01-26","2022-08-30","2020-12-08","2020-10-27","2022-08-29","2022-08-29","2022-08-29","2020-09-30","2020-09-30","2020-12-08","2021-01-18","2021-08-04","2022-08-30","2022-08-29","2022-08-29","2022-08-28","2022-08-30","2022-08-30","2022-08-30","2020-12-29"],"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":[["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","23","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","90","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00093010910","CARBAMAZEPIN","TAB 200MG","90","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","68084077725","ACETAMIN","TAB 650MG","30","Select","Select",""],["","43386016106","MISOPROSTOL","TAB 200MCG","12","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00093816601","QUETIAPINE","TAB 50MG","90","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","270","Select","Select",""],["","69842031278","8HR","TAB 650MG","90","Select","Select",""],["","59779054462","ARTHRTS","TAB 650MG","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":""}]}]}