{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIA CREWS","gend":1,"add":"498 CRESCENT WAY APT 146","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1981-01-28","age":"","mstatus":"","insh":"1271214*01","cliId":"","pno":7577130508,"cno":7577130508,"email":"","ename":"","eno":"","pphy":"JORDAN, JASMINE A NP","ppno":7575941850,"pcpadd":"11803 JEFFERSON AVE STE 100,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","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":7575109223,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","Z11.3","NO DATA","N39.0","F41.9","F41.0","M79.7","N95.1","F51.05","D50.9","E66.01","E55.9","Z98.84","R05.9","R09.89","J35.8","J04.0","J02.9","K21.9","K58.9","M19.90","Z79.899","Z20.822","Z68.43","R11.10","D50.8","D72.829","R53.82","R39.15","H92.03","G89.29","U07.1","A41.9","N12.","Z28.310","J04.30","N76.0","H66.90","R10.11","R10.31","R11.2","J01.90","A59.9","A74.9","Z09.","B37.3","B37.0","R39.9","Z87.898","T14.91XA","F32.9","T50.901A","R30.0","Z00.00","Z13.1","Z13.220","Z12.31","N30.00","B96.89","T42.4X2A","T40.722A","Z02.2","K58.0","N89.8","L25.8","L08.9","B96.20","R35.0","Z51.81","F33.2","J01.10","Z87.440","K64.4","R19.7","R10.84","M54.6","S40.012A","R10.13","R10.12","Z90.49"],"date":["2023-02-27","2023-04-13","2022-05-30","2022-08-10","2023-06-30","2023-06-30","2023-06-30","2022-08-15","2023-06-30","2022-08-15","2023-06-30","2023-06-30","2023-09-08","2022-11-22","2022-07-07","2022-07-07","2022-07-07","2023-06-30","2022-08-10","2022-07-21","2022-07-21","2022-07-21","2022-08-08","2022-09-10","2023-09-08","2021-04-01","2022-08-08","2021-11-30","2022-11-07","2021-11-30","2021-11-30","2022-07-27","2022-08-15","2022-08-08","2022-08-08","2022-08-11","2023-06-17","2021-07-20","2023-08-17","2023-02-27","2023-09-08","2023-06-12","2021-07-20","2021-07-20","2022-08-15","2022-08-15","2022-08-15","2023-04-13","2023-04-13","2022-12-03","2022-12-04","2022-12-04","2023-06-17","2023-06-30","2022-06-30","2022-06-30","2023-06-30","2022-11-07","2022-11-07","2022-12-03","2022-12-03","2022-12-06","2022-12-06","2022-12-06","2021-04-30","2021-04-30","2021-07-15","2023-06-12","2023-06-30","2023-06-30","2023-06-30","2023-06-30","2023-09-08","2023-09-08","2023-09-08","2023-08-17","2023-08-17","2023-08-17","2023-08-17","2023-08-17"],"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":[["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","42806071505","BENZONATATE","200 MG","21","Select","Select",""],["","27808008602","HYD POL\/CPM","SUS 10-8\/5ML","70","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","120","Select","Select",""],["","00093031101","LOPERAMIDE","2 MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","69842093108","ACETAMINOPHN","TAB 500MG","90","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","120","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","118","Select","Select",""],["","00781108905","ALPRAZOLAM","2 MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","60","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","68180086211","AZITHROMYCIN","500 MG","5","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","90","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","2","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","78112080125",""," ","18","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","70","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","61269022063","CLOTRIMAZOLE","CRE 1% VAG","45","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","71930002643","BROM\/PSE\/DM","SYP ","118","Select","Select",""],["","00121086802","NYSTATIN","100000\/ML","300","Select","Select",""],["","33342002332","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00456155060","SAVELLA","TAB 50MG","60","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","70710122701","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300 MG","90","Select","Select",""],["","53746074501","PROMETHAZINE HCL","12.5 MG","120","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","120","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","20","Select","Select",""],["","70710122701","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","10","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","120","Select","Select",""],["","59267102501","PFIZER COVID (","12Y UP) VAC(EUA) 30 MCG\/0.3","0.3","Select","Select",""],["","68382003516","VENLAFAXINE CAP","75MG ER","90","Select","Select",""],["","58657050016","CODEINE\/GG SOL","10-100\/5","118","Select","Select",""],["","53746074501","PROMETHAZINE TAB","12.5MG","120","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","120","Select","Select",""],["","69097084507","CYCLOBENZAPR TAB","5MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","17","Select","Select",""],["","69842093108","ACETAMINOPHN TAB","500MG","90","Select","Select",""],["","00115180401","HYDROXYZ PAM CAP","50MG","120","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","00781108905","ALPRAZOLAM TAB","2MG","90","Select","Select",""],["","64380071306","BENZONATATE CAP","200MG","21","Select","Select",""],["","27808008602","HYD POL\/CPM SUS","10-8\/5ML","70","Select","Select",""],["","00093031101","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00904673080","ACETAMIN TAB","500MG","90","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","12","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","00121077516","GG\/CODEINE SOL","100-10\/5","70","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","10","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","71930002643","BROM\/PSE\/DM SYP","","118","Select","Select",""],["","61269022063","CLOTRIMAZOLE CRE","1% VAG","45","Select","Select",""],["","33342002332","LEVOFLOXACIN TAB","750MG","5","Select","Select",""],["","00121086802","NYSTATIN SUS","100000","300","Select","Select",""],["","70436015542","PROMETHAZINE SOL DM","","118","Select","Select",""],["","35356054560","SAVELLA TAB","50MG","60","Select","Select",""],["","70710122701","AMITRIPTYLIN TAB","50MG","90","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","20","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","90","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","10","Select","Select",""],["","00093100305","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","50111045001","TRAZODONE HCL","150 MG","90","Select","Select",""],["","70436015542","PROMETHAZINE-DM","6.25-15\/5","168","Select","Select",""],["","71930002643","BROMPHENIRAMINE-PSEUDOEPHED-DM","2-30-10\/5","118","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","15","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","58657050016","CODEINE-GUAIFENESIN","10-100MG\/5","70","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","59267030402","PFIZER COVID BIVAL (","12Y UP)EUA 30 MCG\/0.3","0.3","Select","Select",""],["","76385012450","METHOCARBAMOL","750 MG","18","Select","Select",""],["","00574709012","HYDROCORTISONE ACETATE","25 MG","21","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","62559043130","HYDROCORTISONE","2.5 %","30","Select","Select",""],["","59267102501","PFIZER COVID (12Y UP) VAC-GRAY","","0.3","Select","Select",""],["","59267030402","PFIZER COVID BIVAL (12Y UP)","EUA","0.3","Select","Select",""],["","47781001401","HYOSCYAMINE SULFATE ER","0.375 MG","60","Select","Select",""],["","71930005552","ACETAMINOPHEN-CODEINE","300MG-30MG","10","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":""}]}]}