{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYDNEY  A LATHAM","gend":1,"add":"1287 OCEAN VIEW AVE APT 2","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1997-10-11","age":"","mstatus":"","insh":"1876446*01","cliId":"","pno":7573519491,"cno":7573519491,"email":"","ename":"","eno":"","pphy":"WARE, JENNIFER L MD","ppno":7573889925,"pcpadd":"7401 GRANBY ST","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579658519,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","E10.65","E10.9","Z79.4","B35.4","E10.10","U07.1","R79.89","D72.829","R11.2","Z96.41","F31.30","F17.210","Z20.822","V58.69","Z91.128","NO DATA","F31.32","F14.90","F10.10","F60.3","F10.20","F39.","R00.0","F31.9","R50.9","R07.9","F43.25","T50.902A","E86.0","F41.9","Z87.440","Z81.8","Z83.3","Z82.3","G43.909","Z79.899","Z91.14","V58.89","J02.9","F31.31","T65.92XA","H66.91","H72.91","R07.0","T50.904A","E16.2","Z72.0","F33.1","L70.9","Z23.","N12.","R10.9","N39.0","R31.9","N93.9","V62.84","E87.2","F19.10","S51.811A","F10.129","F43.9","J06.9","R03.0","N39.3","E11.65","R53.83","T43.222A","F31.81","J45.909","F15.10","T43.592A","T39.1X2A","F17.290","F19.94","E10.649","T50.902S","R00.2","H90.0","R07.89","D50.9","E10.69","E87.0","F14.20","F17.200","E11.9","R94.01","Z02.2"],"date":["2023-01-13","2023-03-30","2023-03-25","2023-03-30","2021-07-06","2022-09-22","2022-01-13","2022-01-14","2022-12-18","2022-01-13","2023-01-22","2022-07-07","2023-03-30","2023-03-21","2022-09-21","2022-08-23","2023-03-28","2023-01-13","2023-03-27","2023-03-21","2023-03-28","2023-04-18","2023-03-28","2022-12-17","2023-01-22","2022-01-07","2022-01-13","2022-12-20","2022-12-20","2022-09-21","2022-12-17","2022-09-21","2022-09-21","2022-12-17","2022-09-21","2022-09-21","2022-09-21","2022-09-21","2022-12-20","2023-01-31","2021-09-10","2022-08-23","2021-11-16","2021-11-16","2021-11-16","2022-12-17","2022-09-21","2022-11-30","2022-11-30","2022-11-30","2022-11-30","2021-09-09","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2023-03-29","2022-09-22","2023-03-29","2023-01-22","2023-01-22","2023-01-27","2023-02-02","2023-02-02","2021-12-27","2022-12-17","2022-12-18","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2021-03-16","2022-12-19","2021-02-24","2021-11-30","2022-01-13","2022-01-13","2022-12-18","2022-12-18","2023-04-18","2023-04-18","2023-03-23","2023-03-23","2023-03-30"],"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":[["","00002751017","HUMALOG","100\/ML","3","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","16","Select","Select",""],["","64380080807","IBUPROFEN","600 MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00555032302","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","8","Select","Select",""],["","00002773701","INSULIN LISP","INJ 100\/ML","30","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65862009620","CEFPODOXIME","TAB 200MG","20","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","49483034150","ACETAMINOPHN","TAB 500MG","20","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","08627001601","DEXCOM G6","MIS TRANSMIT","1","Select","Select",""],["","08508200005","OMNIPOD DASH","MIS PODS","10","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","08290324912","INSULIN SYRG","MIS 1ML\/31G","100","Select","Select",""],["","81131031250","MELATONIN","TAB 3MG","30","Select","Select",""],["","63323059403","GLUCAGON","INJ 1MG","1","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","00472011745","TRETINOIN","0.025 %","45","Select","Select",""],["","08508200005","OMNIPOD DASH PODS (GEN","4)","5","Select","Select",""],["","00378210001","LOPERAMIDE","2 MG","30","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","90","Select","Select",""],["","49483008010","SENNA","8.6 MG","30","Select","Select",""],["","43547035210","LISINOPRIL","5 MG","30","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","00904530780","BANOPHEN","50 MG","30","Select","Select",""],["","49483034010","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","16729014501","QUETIAPINE FUMARATE","25 MG","30","Select","Select",""],["","00536340501","NICOTINE GUM","4 MG","100","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","30","Select","Select",""],["","63824071016","CEPACOL SORE THROAT","15MG-3.6MG","28","Select","Select",""],["","00761055520","VITAMIN B-","1 100 MG","30","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","3","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","3","Select","Select",""],["","00406117003","NALTREXONE HCL","50 MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","13668033005","TRAZODONE HCL","50 MG","30","Select","Select",""],["","65757030001","VIVITROL","380 MG","1","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":""}]}]}