{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLOS   J EBRON","gend":0,"add":"511A RANDOLPH ROAD","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1984-12-04","age":"","mstatus":"","insh":"2175271*01","cliId":"","pno":"757\/698-5717","cno":"757\/698-5717","email":"","ename":"","eno":"","pphy":"HERRE, JOHN MILTON MD","ppno":"757\/388-3934","pcpadd":"600 GRESHAM DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Advanced Heart Failure Clinic","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/388-2957","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.23","I50.9","D86.9","Z95.810","N18.3","Z01.818","I13.0","I50.42","I42.8","E55.9","K21.9","F41.9","Z76.82","Z79.899","Z87.891","Z82.49","Z83.3","D86.89","N19.","R57.0","I47.2","Z94.1","I25.811","I37.1","E08.21","M25.561","Z48.21","NO DATA","E78.5","Z88.6","Z91.018","Z51.81","I10.","F17.210","I50.22","I50.20","J95.821","Z98.890","Z11.59","I11.0","Z87.74","D84.9","H04.123","R53.81","R53.1","Z51.5","N18.9","D86.85","R06.2","E11.9","Z79.4","E09.9","T38.0X5A","E11.65","Z00.00","E11.8","Z91.19","Z79.52","I36.1","Z86.79","B34.9","Z20.822","I42.2","R60.9","I13.10","Z11.9","Z95.811","Z79.84","Z79.818","D72.819","G25.1","I12.9","Z91.013","Z86.2","Z13.6","I08.1","I42.0","I51.7","R25.1","K75.81","J06.9","R05.","J96.01","I50.43","N17.9","D62.","E11.22","D69.6","T45.1X5A","R73.9","G47.00","I31.3","Z23.","Z87.09"],"date":["2020-05-08","2022-05-17","2022-08-01","2020-04-21","2020-09-21","2020-05-06","2022-05-17","2020-05-15","2021-02-22","2020-05-21","2022-05-17","2020-03-27","2020-05-08","2022-08-01","2022-05-17","2022-05-17","2021-11-29","2020-07-09","2020-05-01","2020-05-11","2020-05-07","2022-08-01","2021-05-05","2021-05-03","2021-05-03","2021-05-30","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-05-17","2022-08-01","2020-01-06","2021-03-29","2020-05-03","2020-05-21","2020-10-21","2020-07-21","2021-02-22","2021-02-22","2021-08-02","2021-12-27","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-04-30","2020-04-21","2020-05-15","2020-05-21","2020-07-29","2020-07-29","2020-07-29","2020-05-21","2021-02-01","2020-08-03","2020-08-03","2020-10-21","2021-08-02","2022-01-03","2022-01-03","2020-01-08","2020-01-16","2020-05-11","2020-05-08","2020-05-11","2020-07-09","2020-07-06","2021-01-18","2021-01-18","2022-05-17","2021-05-03","2021-05-03","2022-05-17","2020-02-24","2020-05-21","2020-08-24","2021-01-18","2020-06-24","2020-02-15","2020-02-15","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-05-21","2020-05-21","2020-07-09","2020-12-21","2020-07-09"],"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":[]},{"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":[["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","00781210301","TACROLIMUS","CAP 1MG","180","Select","Select",""],["","00781206705","MYCOPHENOLAT","CAP 250MG","60","Select","Select",""],["","00228277811","PROPRANOLOL","CAP 60MG ER","90","Select","Select",""],["","55111022990","PRAVASTATIN","TAB 10MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","49348081709","ACID","TAB 20MG","180","Select","Select",""],["","00054472831","PREDNISONE","TAB 5MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","120","Select","Select",""],["","55513080060","CORLANOR","TAB 5MG","180","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","240","Select","Select",""],["","49035091530","OMEPRAZOLE","TAB 20MG","28","Select","Select",""],["","00121081016","NYSTATIN","SUS 100000","473","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","21","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","53885065701","ONETOUCH","KIT VERIO","1","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","12","Select","Select",""],["","65162069388","ATOVAQUONE","SUS 750\/5ML","300","Select","Select",""],["","00603020922","MAG","TAB 400MG","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","65862075360","VALGANCICLOV","TAB 450MG","60","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","49035065082","EQ","TAB 20MG","60","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":""}]}]}