{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAVERNE BIAS","gend":1,"add":"636 RIDGEWAY AVE","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1956-12-09","age":"","mstatus":"","insh":"20023895*01","cliId":"","pno":7575133693,"cno":7575133693,"email":"","ename":"","eno":"","pphy":"SALAZAR, JUAN S MD","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":"OHCC","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":["F11.220","I10.","K74.60","R18.8","U07.1","B20.","F11.20","M79.651","B18.2","Z68.32","NO DATA","R60.0","B19.20","Z21.","Z79.899","Z87.891","Z88.8","Z23.","Z68.33","M79.604","Z00.00","Z12.31","Z12.4","D69.6","F11.10","E78.00","F17.200","M79.89","Z12.2","F17.211","R91.8","K83.8","K86.89","Z13.810","K76.6","K31.89","K74.69","Z91.81"],"date":["2023-03-31","2023-09-01","2023-09-01","2022-10-06","2023-01-06","2023-09-01","2022-09-12","2021-09-20","2023-09-01","2021-01-19","2023-09-01","2023-04-05","2023-04-05","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2022-10-13","2021-07-06","2021-09-20","2022-07-26","2023-09-01","2022-07-26","2023-09-01","2023-09-01","2022-07-26","2022-07-26","2021-09-20","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2023-04-10","2023-04-10","2023-04-10","2023-05-17","2023-09-01"],"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":[["","65649030302","XIFAXAN","550 MG","60","Select","Select",""],["","59676056201","PREZISTA","600 MG","60","Select","Select",""],["","61958200201","DESCOVY","200MG-25MG","30","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","60","Select","Select",""],["","50090108502","ISENTRESS","400 MG","30","Select","Select",""],["","31722059730","RITONAVIR","100 MG","60","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","16729022601","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","16714098901","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","53746051401","SPIRONOLACTONE","50 MG","30","Select","Select",""],["","50268070915","ROSUVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","65649030302","XIFAXAN TAB","550MG","60","Select","Select",""],["","59676056201","PREZISTA TAB","600MG","60","Select","Select",""],["","00006022761","ISENTRESS TAB","400MG","60","Select","Select",""],["","61958200201","DESCOVY TAB","200\/25MG","30","Select","Select",""],["","00054040713","RITONAVIR TAB","100MG","60","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","16729022601","SPIRONOLACT TAB","50MG","30","Select","Select",""],["","16714098901","ROSUVASTATIN TAB","10MG","30","Select","Select",""],["","60505257909","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","00480773606","DARUNAVIR","600 MG","180","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":""}]}]}