{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHASE DOZIER","gend":0,"add":"14013 LAUREL OAK DR","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1997-10-27","age":"","mstatus":"","insh":"20026661*01","cliId":"","pno":7576969435,"cno":7576969435,"email":"","ename":"","eno":"","pphy":"BADIYE, AMIT P MD","ppno":7572529365,"pcpadd":"2075 GLENN MITCHELL DR STE 400,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Advanced Heart Failure Clinic","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579627217,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","I10.","I42.8","G47.33","G43.019","E66.01","R10.33","I42.9","I50.9","G47.30","S61.202A"],"date":["2023-02-09","2023-02-09","2023-02-09","2023-02-09","2021-11-08","2021-09-30","2023-01-09","2023-01-09","2023-01-09","2023-01-09","2023-06-02"],"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":[["","68382009801","PAROXETINE TAB","20MG","30","Select","Select",""],["","69238149101","BUMETANIDE TAB","2MG","60","Select","Select",""],["","16729022501","SPIRONOLACT TAB","25MG","30","Select","Select",""],["","69238106901","POT CHLORIDE TAB","20MEQ ER","60","Select","Select",""],["","00078069620","ENTRESTO TAB","97-103MG","60","Select","Select",""],["","31722059101","METOPROL SUC TAB","100MG ER","180","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","180","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00093310953","AMOXICILLIN CAP","500MG","40","Select","Select",""],["","53746051101","SPIRONOLACTONE","25 MG","30","Select","Select",""],["","72516003201","METOPROLOL SUCCINATE","100 MG","180","Select","Select",""],["","00078069620","ENTRESTO","97MG-103MG","60","Select","Select",""],["","67877084201","FAMOTIDINE","20 MG","180","Select","Select",""],["","69238149101","BUMETANIDE","2 MG","60","Select","Select",""],["","69238106901","POTASSIUM CHLORIDE","20 MEQ","180","Select","Select",""],["","00093310953","AMOXICILLIN","500 MG","40","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","68382009801","PAROXETINE","TAB 20MG","30","Select","Select",""],["","69238106901","POT CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","31722059101","METOPROL SUC","TAB 100MG ER","180","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","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":""}]}]}