{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIAN   H GALE","gend":0,"add":"1708 S CHURCH ST APT A","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1980-10-16","age":"","mstatus":"","insh":"2259380*01","cliId":"","pno":"757\/641-3640","cno":"757\/641-3640","email":"","ename":"","eno":"","pphy":"LOPRESTI, BARTHOLOMEW M MD","ppno":"757\/542-2000","pcpadd":"STE 200 20209 SENTARA WAY","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - St. Luke's","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/542-2001","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S82.009A","S82.001A","H25.13","H17.823","F41.9","F10.20","S82.041A","V89.9XXA","V54.16","F31.81","S90.01XA","F41.1","S90.31XA","I10.","F10.10","S82.041P","R07.9","V89.2XXA","F84.9","L98.9","H61.21","T14.90XA","R69.","M25.561","Z01.00","E78.2","N52.9","H50.60","H50.9","D64.9","E02.","E53.8","Z00.00","R79.89","R73.03","R26.2","E66.01","F31.9","Z68.36","T88.4XXA","S83.004A","L03.211","J95.821","S50.11XA","F32.9","E66.09","E87.6","R00.0","Z20.828","Z68.34","Z78.1","R03.0","Z96.9","R60.0","K13.0","S00.81XA","H61.20","J96.01","Z99.11","Z11.52"],"date":["2020-06-12","2020-06-12","2020-11-09","2020-11-09","2022-10-17","2022-10-17","2020-05-30","2020-05-30","2020-10-28","2022-02-24","2020-06-12","2022-02-24","2020-06-12","2022-08-08","2020-06-12","2020-06-30","2020-05-30","2020-05-30","2020-06-09","2022-08-08","2020-01-19","2020-05-29","2020-05-29","2020-08-18","2020-10-28","2022-02-24","2020-10-28","2022-02-24","2020-10-28","2022-02-24","2020-10-28","2020-10-28","2022-02-24","2022-02-24","2022-02-24","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2020-06-09","2020-06-09","2022-08-20","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-09-22","2020-09-22","2021-10-25","2021-10-25","2022-07-07","2020-01-23","2020-06-01","2020-05-31","2022-05-16"],"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":[["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","51672413101","LAMOTRIGINE","TAB 100MG","60","Select","Select",""],["","62756018388","OXCARBAZEPIN","TAB 150MG","60","Select","Select",""],["","00456114030","VIIBRYD","TAB 40MG","30","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","62332023430","VILAZODONE","TAB 40MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","3","Select","Select",""],["","42037010478","DEBROX","SOL 6.5% OT","15","Select","Select",""],["","69097081307","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","50742061501","METOPROL","TAB 25MG ER","30","Select","Select",""],["","13668044201","CELECOXIB","CAP 200MG","60","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","19","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","60","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}