{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY   S CLAYTON","gend":1,"add":"219 HANKINS DR","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1963-07-08","age":"","mstatus":"","insh":"6055230*01","cliId":"","pno":"757\/256-0096","cno":"757\/256-0096","email":"","ename":"","eno":"","pphy":"EMECHEBE, NONSO S MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9802","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.811","J45.40","J44.9","J30.9","R06.02","Z01.812","Z11.59","E21.3","E21.0","J38.4","M25.50","M79.7","M25.561","M25.461","L60.0","M79.671","M79.672","M20.12","B35.1","L60.2","M79.675","M20.11","M79.674","M54.6","R09.1","E07.9","Z79.899","Z79.51","F17.210","Z98.51","Z91.013","Z20.822","M20.41","G57.11","Z23.","E55.9","F33.1","F17.200","M17.0","L03.221","M21.612","K21.9","Z79.1","M54.12","M65.322","M65.312","H92.02","H60.513","H92.12","L29.9","J38.1","E04.1","R49.0","Z01.818","S93.124A","NO DATA","Z90.710","S93.129A","L30.9","Z71.9","E04.2","B36.9","H62.40","I10.","R10.32","R23.2","Z90.711","M47.22","M54.2","Z72.0","M47.812","G43.709","H60.502","F43.22","R42.","H60.8X3","H61.23","M25.512","G43.909","R20.2","M19.90","M85.80","R53.83","E83.51","J38.2","Z11.4","R51.9","E83.52","H73.002","H60.511","H92.01","V58.89","J43.9","Z96.5","H53.149","R06.83","R40.0","E66.9","Z68.34","R94.39","Z01.810","Z96.698","T85.848A","H60.501","M85.89","M65.311","M65.321"],"date":["2021-05-06","2022-01-14","2022-11-01","2022-11-01","2020-03-25","2020-05-16","2022-08-17","2022-11-01","2020-05-18","2020-05-18","2022-05-06","2022-10-03","2021-11-16","2021-11-16","2021-12-22","2022-03-16","2022-09-09","2022-09-09","2021-12-22","2021-12-22","2022-03-16","2022-03-16","2022-03-16","2021-12-23","2021-12-23","2022-09-09","2022-09-30","2022-09-30","2022-09-30","2021-12-23","2022-09-30","2022-02-07","2022-03-16","2022-03-21","2022-11-01","2022-03-21","2022-09-09","2022-10-17","2022-10-03","2022-08-23","2022-09-09","2022-11-01","2022-09-09","2022-10-03","2020-10-23","2020-10-23","2021-05-24","2021-05-24","2021-05-24","2021-05-20","2021-06-24","2022-09-02","2022-05-09","2022-08-17","2022-02-11","2022-09-30","2022-02-11","2022-02-11","2022-08-26","2022-08-26","2020-09-30","2021-04-22","2021-04-22","2021-06-24","2020-09-30","2020-09-30","2020-09-30","2020-11-11","2022-09-30","2020-11-19","2021-04-27","2021-04-27","2021-04-27","2021-11-03","2022-05-06","2022-09-02","2022-09-02","2020-11-02","2022-10-17","2022-10-03","2022-07-22","2022-07-22","2022-10-03","2020-08-03","2021-05-26","2022-08-17","2022-09-30","2020-05-18","2021-05-18","2021-05-18","2021-05-18","2022-02-11","2022-09-30","2022-09-30","2022-09-30","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2020-03-05","2020-03-05","2022-03-16","2022-03-16","2021-02-15","2022-10-03","2022-10-03","2022-10-03"],"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":[["","72205001590","PREGABALIN","CAP 150MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","51672130104","AMMONIUM","CRE 0.12","280","Select","Select",""],["","62332014231","CELECOXIB","CAP 200MG","30","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","30","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00487950125","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","16714012302","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","68645057054","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","31722094901","OXYCOD\/APAP","TAB 5-325MG","28","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00067611730","ALLERGY","TAB 10MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","49035019502","EQ","DIS 14MG\/24H","28","Select","Select",""],["","50383088915","ACETIC","SOL 2% OTIC","15","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","00065853110","CIPRO","SUS OTIC","10","Select","Select",""],["","51672203701","CLOTRIMAZOLE","SOL 0.01","10","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","20","Select","Select",""],["","50228046601","NABUMETONE","TAB 750MG","60","Select","Select",""],["","00172572970","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","71093011205","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","00904585652","CALCIUM","TAB 600MG","56","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","00904546080","OYST","TAB 500MG","60","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","300","Select","Select",""],["","00168025846","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","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":[]}},{"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":""}]}]}