{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMARA BROWN","gend":1,"add":"903 FOREST LAKE CTS APT 101","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1984-03-04","age":"","mstatus":"","insh":"1124202*01","cliId":"","pno":7577386200,"cno":7577386200,"email":"","ename":"","eno":"","pphy":"FABIAN-GOTTLIEB, ARLENE P PA","ppno":7578272025,"pcpadd":"4001 COLISEUM DR STE 300,","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","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":7572759802,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","R06.02","F33.2","F06.32","F06.4","G47.33","F32.9","K12.0","I10.","Z87.891","Z79.899","Z88.0","K08.89","NO DATA","R13.14","E66.9","K21.9","G40.909","Z86.16","F41.9","Z68.42","F33.0","N92.6","K27.9","R10.2","F31.60","G47.01","M54.9","F39.","K29.40","Z09.","R73.03","Z13.29","R05.","F33.3","J30.9","M79.669","L30.9","Z11.59","F25.9","F19.10","G81.91","J96.01","Z68.41","G61.0","G40.802","H15.832","H35.422","H53.002","H53.122","R06.00","R50.9","M79.89","G47.61","R09.82","Z00.00","Z12.4","N89.8","R56.9","H61.23","Z12.39","U07.1","M79.661","M79.662","I87.2","Z71.89","E55.9","Z53.20","J30.89","R53.81","R53.83","G47.9","R60.9","M79.604","M79.605","M79.651","G62.9","G61.81","F14.21","F31.81","Z86.69","K08.9","B34.9","Z20.822","M79.2","G43.109","N92.1","Z28.310","J02.9","I16.0","S16.1XXA","J00."],"date":["2021-11-03","2021-04-07","2023-04-12","2022-08-31","2022-08-31","2023-05-03","2023-01-02","2022-04-06","2023-06-09","2023-05-03","2022-03-19","2022-03-19","2022-03-19","2023-05-03","2021-05-10","2021-06-13","2021-06-13","2023-05-03","2023-05-03","2023-05-03","2021-06-13","2021-07-06","2021-10-22","2023-02-15","2021-10-22","2022-12-08","2022-12-08","2022-06-12","2021-11-03","2021-05-10","2022-04-06","2022-04-06","2022-04-06","2021-04-02","2021-02-09","2021-07-12","2021-04-09","2021-04-09","2021-04-09","2023-02-15","2022-06-07","2023-02-15","2021-04-09","2023-02-15","2023-02-15","2021-04-09","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2022-06-07","2021-01-13","2021-04-06","2021-03-07","2021-07-12","2022-06-07","2022-06-07","2022-06-07","2023-04-12","2022-06-07","2022-06-07","2021-01-25","2021-04-06","2021-04-06","2021-04-06","2021-08-18","2023-02-15","2023-02-15","2023-02-15","2021-01-18","2021-01-18","2021-03-09","2021-04-06","2021-04-06","2021-04-06","2021-06-18","2023-04-12","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2022-03-29","2023-05-03","2023-06-09","2023-04-12","2023-04-12","2023-07-19","2023-05-03","2023-05-03","2023-06-09","2023-06-09","2023-06-09"],"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":[["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","31722070090","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","59779045806","CVS ALLERGY","TAB 10MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69315012710","FOLIC ACID","TAB 1000MCG","30","Select","Select",""],["","59651017701","DOXEPIN HCL","100 MG","30","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","43598029690","PREGABALIN","200 MG","60","Select","Select",""],["","33342032715","TRIAMCINOLON","CRE 0.00025","15","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00527193206","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","28","Select","Select",""],["","24208039830","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","63402030630","LATUDA","60 MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00168029315","CLOBETASOL","GEL 0.0005","15","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","61874011530","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","75834002001","VITAMIN D","3 1250 MCG","12","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","30","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","43598029690","PREGABALIN CAP","200MG","60","Select","Select",""],["","60505083305","AZELASTINE SPR","0.1%","30","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","60","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","30","Select","Select",""],["","24208039830","IPRATROPIUM SPR","0.03%","30","Select","Select",""],["","65862059501","DIVALPROEX TAB","500MG ER","60","Select","Select",""],["","00168029315","CLOBETASOL GEL","0.05%","15","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","67877021560","CEFUROXIME TAB","250MG","20","Select","Select",""],["","60432046400","LIDOCAINE SOL","2% VISC","100","Select","Select",""],["","59651017701","DOXEPIN HCL CAP","100MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","63402030630","LATUDA TAB","60MG","30","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","20","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","61874011530","VRAYLAR CAP","1.5MG","30","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","15","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","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":""}]}]}