{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHINA NEAL","gend":1,"add":"470 CEDAR DR APT I","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"2000-11-24","age":"","mstatus":"","insh":"6767451*01","cliId":"","pno":"757\/232-9547","cno":"757\/907-3544","email":"","ename":"","eno":"","pphy":"ESCALERA, KIMBERLY S NP","ppno":"757\/984-9650","pcpadd":"477 MCLAWS CIR STE 1","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Kingsmill","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9232","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S27.2XXA","G89.18","G89.11","M79.602","M79.604","S27.1XXA","R00.0","V48.6XXA","Y92.410","Z88.0","Z88.6","I49.9","J94.2","V89.9XXA","S21.109S","V54.12","M96.89","L08.9","E86.0","T81.32XA","A41.9","V58.89","M79.89","Z96.9","F17.210","G89.29","Z79.01","Z79.899","Z88.1","S52.362C","S55.102A","S82.201A","Y24.9XXA","S21.101A","Z33.1","Z3A.27","V89.2XXA","S52.302B","V49.9XXA","M86.161","B95.2","B95.1","B96.89","Z47.2","M23.91","N91.2","Z11.3","Z11.9","R35.0","A60.00","O14.10","O76.","Z3A.26","Z37.0","W34.00XA","S51.832A","S21.031A","S81.831A","O14.14","M79.605","R94.31","S41.102A","S81.802A","Z11.59","M79.632","S52.90XA","X95.9XXD","S81.801A","V54.16","J06.9","J20.9","R05.","I10.","R73.9","D64.9","F43.10","S49.92XS","G89.4","M79.622","H53.9","R51.","Z3A.25","O9A.213","S82.201B","S51.841A","X95.9XXA","S56.422A","O9A.212","J91.8","O15.02","O14.15","F43.22","S27.0XXA","S21.001A","S82.251A","S51.851A","G89.21","R20.3","NO DATA","F41.9","F32.9","S52.352B","S52.252B","S51.801A","S51.802A","M54.2","M54.9","T14.90XA","L76.82","V49.59XA","T84.622A","B96.1","Z87.891","R09.89","O9A.22","S52.302C","S82.291B","S56.522A","S55.112A","E87.1","O98.32","O98.82","J90.","O11.4","O10.02","S54.20XA","O99.02","D64.89","O26.892","Z51.89","Z48.02","W34.00XD","M79.601","M25.561","N93.8","K64.9","N94.9","N30.01","S49.90XA","S52.352C","V43.61XA","S52.362N","D36.12","R55.","R06.02","M25.532","T84.84XA","S52.301A","J95.2","D62.","F05.","S52.252C","F43.0","Z20.828","Z72.0","Z47.89","T84.623A","G04.91","T81.30XA","F17.200","R21.","T36.8X5A","Z81.8","R20.8"],"date":["2020-06-23","2021-04-16","2020-06-27","2021-10-06","2021-12-07","2020-07-11","2020-11-28","2020-07-10","2020-07-10","2021-12-16","2021-12-16","2020-07-11","2020-07-14","2020-07-11","2020-07-14","2020-08-18","2020-08-30","2020-08-30","2020-08-30","2020-09-25","2020-10-17","2020-11-23","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2020-06-18","2020-06-18","2020-06-18","2020-06-20","2020-06-18","2020-06-18","2020-06-19","2020-07-14","2020-07-15","2020-07-15","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2021-12-16","2021-06-07","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-23","2020-06-18","2020-06-20","2020-06-18","2020-06-18","2021-10-06","2020-06-22","2020-07-20","2020-07-20","2020-08-26","2020-08-29","2020-08-28","2020-09-19","2020-11-23","2021-12-15","2020-11-28","2020-11-28","2020-11-28","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2020-06-06","2020-06-06","2020-06-18","2020-06-20","2020-06-18","2020-06-26","2020-06-18","2020-06-19","2020-06-19","2020-06-19","2020-06-20","2020-06-22","2020-06-25","2020-06-26","2020-09-10","2020-09-10","2021-11-26","2021-11-26","2021-11-26","2021-12-07","2021-12-07","2020-06-15","2020-06-15","2020-06-15","2020-08-07","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-09-28","2020-09-28","2021-10-06","2020-11-28","2020-06-15","2020-06-21","2020-06-15","2020-06-20","2020-06-20","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-07-29","2020-07-29","2021-03-23","2021-10-06","2021-10-06","2019-04-14","2019-09-29","2019-09-29","2019-09-29","2020-06-15","2020-06-20","2020-07-10","2020-08-28","2020-08-28","2020-08-29","2021-03-18","2021-03-18","2021-12-16","2020-06-15","2020-06-21","2020-09-18","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-09-08","2020-09-18","2020-09-18","2020-09-18","2021-04-17","2020-09-18","2020-09-18","2021-04-17","2021-11-26"],"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":[["","","PROCTOFOAM"," PROCTOFOAM ","10","Select","Select",""],["","","NITROFURANTN"," NITROFURANTN ","10","Select","Select",""],["","","VALACYCLOVIR"," VALACYCLOVIR ","20","Select","Select",""],["","","DOCUSATE"," DOCUSATE ","30","Select","Select",""],["","","HYDROXYZ","TAB 10MG","","Select","Select",""],["","","HYDROMORPHON","TAB 2MG","","Select","Select",""],["","","MAGNESIUM","TAB 200MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","QUETIAPINE","TAB 100MG","","Select","Select",""],["","","GABAPENTIN","CAP 400MG","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","XARELTO","TAB 20MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","","BACITRACIN","OIN 500\/GM","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","ENOXAPARIN","INJ 40\/0.4ML","","Select","Select",""],["","","PRENATAL","TAB 27-0.8MG","","Select","Select",""],["","","SENNA","TAB 8.6MG","","Select","Select",""],["","","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","","BACITR","OIN 500\/GM","","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","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":""}]}]}