{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDWARD SALTER","gend":0,"add":"5827 BURTON STATION RD UNIT 312","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1959-01-09","age":"","mstatus":"","insh":"2222294*01","cliId":"","pno":"757\/977-3494","cno":"","email":"","ename":"","eno":"","pphy":"URENA HERNANDEZ, JOHAN S MD","ppno":"757\/252-9800","pcpadd":"1380 TUSCANY DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Nimmo","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9793","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F43.10","F10.20","M79.671","R35.0","I10.","F33.9","Z01.818","I77.9","I73.9","I70.221","I99.8","Z12.11","I50.9","J43.9","B19.20","N52.9","F11.20","F39.","R07.9","M20.11","I70.201","M20.41","Z48.01","M54.5","M79.672","R60.0","Z98.890","F31.0","F19.20","R07.89","I70.209","G89.18","M20.12","L97.529","L97.519","L60.0","R26.89","R35.1","T78.40XA","F19.21","F41.1","E11.42","M77.42","M20.42","N32.81","N40.1","H02.052","H02.055","NO DATA","H43.813","H25.13","H47.393","E87.6","I50.22","J43.2","B18.2","I25.709","V58.89","I70.202","G57.62","M19.072","F17.200","G57.52","G62.9","G89.4","M79.2","G60.9","I70.211","R79.89","Z01.810","Z01.812","R94.31","S85.902A","Z47.89","I13.0","N18.3","I25.10","M47.812","N28.1","F17.210","Z79.82","Z91.81","R06.02","R69.","M77.41","T81.30XA","R60.1","F15.921","F10.10","F11.21","R60.9","I70.212","I72.4","L97.511","G57.51","G57.61","Z00.00","Z12.5","Z11.3","G89.29","I77.1","I70.92","G63.","L97.521","L97.522","Z23.","F32.9","K22.70","R10.9","I11.0","M54.16","V49.50XA","Y93.9","Y92.410","M25.511","M25.512","R58.","T79.A21A","M79.89","Z11.59","G60.3","R39.9","I51.7","N32.9","F19.10","Z72.0","E11.9","M20.40","L84.","I70.213","R31.29","I08.0","J01.00","R05."],"date":["2021-06-03","2021-07-22","2021-09-14","2021-12-14","2021-10-11","2021-12-17","2021-12-30","2020-11-12","2020-01-14","2021-05-11","2020-02-20","2020-02-20","2020-02-26","2020-06-20","2020-06-20","2020-02-26","2021-03-04","2021-05-03","2021-07-01","2020-05-03","2020-11-12","2020-09-05","2021-04-20","2021-03-06","2020-10-21","2021-12-14","2021-12-14","2021-11-23","2021-06-03","2020-01-23","2020-05-04","2020-05-11","2020-07-01","2020-11-12","2021-04-20","2020-08-12","2021-01-26","2021-02-24","2021-03-04","2021-03-04","2021-06-03","2021-09-14","2021-12-14","2021-11-04","2021-11-04","2021-12-02","2021-12-02","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-01-11","2021-01-11","2021-01-11","2021-05-11","2021-01-11","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-10-01","2021-12-17","2021-12-16","2021-12-16","2021-12-16","2020-02-20","2020-01-17","2020-02-14","2020-02-14","2020-11-11","2020-05-15","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-07-22","2020-06-20","2020-06-20","2020-05-03","2020-05-14","2020-06-23","2020-08-11","2021-04-19","2021-07-01","2021-07-01","2021-07-01","2020-05-29","2020-05-15","2020-05-15","2020-09-02","2021-10-01","2021-02-02","2021-05-11","2021-05-11","2021-05-11","2021-07-20","2020-05-14","2020-05-14","2020-06-09","2020-07-13","2020-07-29","2020-09-02","2020-09-02","2020-03-18","2020-03-18","2020-03-18","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2021-07-20","2021-07-20","2020-05-15","2020-05-15","2020-05-29","2020-06-29","2021-12-14","2019-11-18","2019-11-08","2019-09-12","2019-09-12","2019-09-12","2019-11-25","2019-11-25","2019-11-25","2019-12-20","2019-10-11","2019-12-11","2019-10-23","2019-10-23"],"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":[["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","","OXYCOD\/APAP","TAB 10-325MG","","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","17478010505","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","72205001290","PREGABALIN","CAP 50MG","60","Select","Select",""],["","","SILDENAFIL","TAB 50MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","2","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","30","Select","Select",""],["","","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","80777027315","MODERNA","INJ COVID-19","0","Select","Select",""],["","68382078301","DOXAZOSIN","TAB 1MG","30","Select","Select",""],["","50228017705","GABAPENTIN","TAB 600MG","60","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","65162037210","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","62332002890","LOSARTAN","TAB 50MG","60","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00093206406","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","60","Select","Select",""],["","29300046801","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","45963014205","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","7","Select","Select",""],["","","MAVYRET","TAB 100-40MG","","Select","Select",""],["","","EQ","DIS 14MG\/24H","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","SSD","CRE 0.01","","Select","Select",""],["","","NICOTINE","DIS 7MG\/24HR","","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","","SM","DIS 7MG\/24HR","","Select","Select",""],["","","BRILINTA","TAB 90MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","CHLOR","LIQ 0.04","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","16714035201","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","69452014320","BENZONATATE","CAP 100MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}