{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VANESSA S BOONE","gend":1,"add":"2540 CRESTWOOD LANE","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1979-01-24","age":"","mstatus":"","insh":"1963874*01","cliId":"","pno":7572702634,"cno":7572702634,"email":"","ename":"","eno":"","pphy":"WADDY, JAMES M MD","ppno":7579832200,"pcpadd":"BLD A SUITE 207 3920 BRIDGE ROAD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Belle Harbour","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579832201,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H16.8","E11.69","E11.59","F32.1","I67.5","Z86.73","E78.00","I15.2","F43.23","T25.022A","E66.01","Z68.36","K44.9","I10.","I34.0","E11.9","E78.5","G47.33","I63.9","D64.9","K21.9","F33.1","Z98.84","R73.03","J06.9","Z20.828","N76.0","Z11.3","Z20.822","I51.7","R94.31","R06.00","NO DATA","Z68.39","R53.83","E11.8","I63.511","I08.1","D25.9","D62.","Z79.01","Z79.899","Z91.018","Z68.37","Z80.3","Z00.00","R11.0","R05.9","M54.9","Z98.890","T30.0","Z79.84","H04.123","N93.9","D25.1","Z12.31","J01.90","R51.9","R09.82","Z01.818","Z68.41","Z01.810","F33.0","F41.9","F50.9","Z12.39","M62.81","S23.3XXA","K91.2","Z86.39","Z68.29","K46.9","G47.30","R56.9","R73.9","G40.909","K40.90","N17.9","Z79.4","Z83.3","Z82.49","Z82.3","Z79.82"],"date":["2022-09-12","2023-03-31","2023-03-31","2023-03-31","2023-04-21","2023-04-21","2023-03-31","2023-03-31","2021-12-11","2022-01-05","2022-08-29","2022-08-11","2022-08-11","2023-04-24","2022-08-11","2023-04-21","2022-08-11","2022-08-11","2022-08-11","2023-04-24","2023-03-23","2023-05-16","2023-04-21","2021-02-01","2021-07-05","2021-09-04","2023-03-20","2023-03-20","2021-09-10","2023-04-21","2023-03-23","2022-02-10","2022-10-28","2022-03-04","2021-07-05","2022-12-09","2022-01-25","2022-02-16","2022-12-13","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-10-28","2022-08-31","2021-10-21","2022-07-28","2022-10-13","2022-12-13","2021-01-19","2021-04-09","2021-04-09","2021-04-23","2021-04-23","2021-04-23","2021-09-01","2021-09-01","2021-09-01","2022-07-11","2022-02-07","2022-02-28","2022-04-07","2022-04-07","2022-04-07","2021-04-21","2021-04-29","2021-09-13","2022-12-09","2022-12-09","2022-12-09","2023-03-23","2023-03-23","2023-04-24","2023-04-24","2023-04-21","2023-03-22","2023-04-21","2023-04-21","2023-04-21","2023-04-21","2023-04-21","2023-04-21"],"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":[["","43547028810","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00006011231","JANUVIA","TAB 50MG","30","Select","Select",""],["","00065064725","TOBRADEX","SUS 0.3-0.1%","5","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","69238137403","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","68180031909","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","65862022660","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","69097052934","ESOMEPRAZOLE","GRA 40MG DR","14","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","180","Select","Select",""],["","59267102503","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00713052612","PROMETHEGAN","SUP 25MG","10","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","71288041083","ENOXAPARIN","INJ 40\/0.4ML","3","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","29300046810","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","10","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","14","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","99073070827","FREESTYLE","TES LITE","100","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","100","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","3","Select","Select",""],["","80056014301","RELTONE","CAP 200MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","3","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","14","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","12","Select","Select",""],["","59779060027","ASPIRIN EC","81 MG","30","Select","Select",""],["","43547022215","LEVETIRACETAM","500 MG","60","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":""}]}]}