{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY   A BOYD","gend":1,"add":"8000 MARSH POINT LN APT 303","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1962-01-09","age":"","mstatus":"","insh":"5714079*01","cliId":"","pno":"540\/773-9147","cno":"","email":"","ename":"","eno":"","pphy":"JORDAN, JASMINE A NP","ppno":"757\/594-1850","pcpadd":"11803 JEFFERSON AVE STE 100","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\/510-9223","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z20.828","R05.","R50.9","R07.0","NO DATA","R51.","R11.2","R43.2","M25.511","R06.02","R06.00","R51.9","M79.601","M75.21","M79.645","Z00.00","Z23.","Z12.11","L70.0","Z78.0","Z12.39","M25.551","I10.","K21.9","R10.33","R19.03","L81.1","Z71.9","S46.211A","M75.51","M75.121","M25.569","M25.561","M79.629","G89.29","Z88.0","Z87.891","V58.89","S46.011A","M19.011","S43.421A","S46.111A","M75.41","D12.5","K08.9","L81.0","Z76.89","Z13.1","E66.09","Z68.32","K59.00","N30.01","R13.14","K22.2","K29.40"],"date":["2021-12-27","2020-10-07","2020-10-07","2020-07-23","2020-07-23","2020-10-07","2020-07-23","2020-07-23","2020-07-23","2021-05-03","2020-10-07","2020-10-07","2020-10-07","2021-02-16","2021-01-27","2021-02-16","2021-06-03","2021-06-03","2019-12-17","2021-04-08","2019-10-28","2019-10-28","2019-10-28","2021-04-08","2019-11-13","2019-11-13","2019-11-13","2020-12-14","2020-12-14","2021-03-05","2021-03-02","2021-03-05","2019-12-20","2019-12-21","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-03-02","2021-03-02","2021-03-02","2021-03-05","2021-03-05","2021-03-05","2020-01-28","2020-10-13","2020-10-13","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2019-12-17","2020-01-23","2019-12-12","2019-12-12","2019-12-12"],"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":[["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","50","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","00046110281","PREMARIN","TAB 0.625MG","30","Select","Select",""],["","53746051501","SPIRONOLACT","TAB 100MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","60003056490","HYLAGUARD","CRE ","450","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","28","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","90","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","58160088552","FLUARIX","INJ 2020-21","0","Select","Select",""],["","65162089129","MOMETASONE","SPR 50MCG","17","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":""}]}]}