{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FREDERICK A HEITMANN","gend":0,"add":"1102 MACDONALD ROAD","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1959-05-03","age":"","mstatus":"","insh":"20028986*01","cliId":"","pno":7573625309,"cno":7573625309,"email":"","ename":"","eno":"","pphy":"GRAYSON JR, MARVYN A MD","ppno":7572525820,"pcpadd":"1933 EDWIN DR STE 208,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23322-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine & Pediatrics - Edinburgh","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579639609,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L40.0","L85.3","L81.0","Z01.818","I71.4","T82.330A","NO DATA","I48.0","I25.10","R20.0","I50.9","Z87.891","Z95.1","Z88.5","Z88.0","Z91.013","Z95.810","Z91.018","Z79.899","Z79.01","Z23.","Z12.2","F17.210","L81.2","Z95.828","R73.9","E11.65","T38.3X5A","B35.1","Z01.810","Z01.812","R94.31","I25.5","L21.8","Z98.890","Z86.79","E78.5","I10.","Z95.5","L72.0"],"date":["2023-09-08","2021-01-21","2021-01-14","2021-08-18","2022-05-17","2021-12-21","2023-07-27","2023-07-27","2021-12-20","2021-12-20","2021-12-20","2022-11-25","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2022-11-25","2022-11-25","2021-01-21","2022-11-29","2022-11-17","2022-12-07","2022-12-01","2022-12-07","2021-08-18","2021-08-18","2021-08-18","2023-07-27","2023-09-08","2022-05-17","2022-05-17","2023-07-27","2023-07-27","2023-07-27","2023-09-08"],"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":[["","68180051303","LISINOPRIL","TAB 5MG","60","Select","Select",""],["","00078063941","COSENTYX PEN","INJ 300DOSE","2","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","50458057930","XARELTO","20 MG","30","Select","Select",""],["","43598083205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00093506105","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","68462016305","CARVEDILOL","6.25 MG","180","Select","Select",""],["","29033003206","METFORMIN ER","TAB 1000MG","90","Select","Select",""],["","43598057530","TADALAFIL","TAB 5MG","30","Select","Select",""],["","70010049105","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","55111032001","GLIMEPIRIDE","1 MG","90","Select","Select",""],["","00078065920","ENTRESTO","24 MG-26MG","180","Select","Select",""],["","57894064011","TREMFYA","100 MG\/ML","1","Select","Select",""],["","45802014167","CICLOPIROX","8 %","6.6","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","90","Select","Select",""],["","00597015230","JARDIANCE","10 MG","30","Select","Select",""],["","00536132213","OMEPRAZOLE","TAB 20MG DR","30","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","23155050105","HYDROXYZINE HCL","25 MG","60","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","65862007930","TERBINAFINE HCL","250 MG","30","Select","Select",""],["","00536132213","OMEPRAZOLE MAGNESIUM","20 MG","90","Select","Select",""],["","00078063941","COSENTYX PEN INJ","300DOSE","2","Select","Select",""],["","68180051303","LISINOPRIL TAB","5MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","00378395205","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","50458057930","XARELTO TAB","20MG","90","Select","Select",""],["","67877025145","TRIAMCINOLON CRE","0.1%","454","Select","Select",""],["","00093506105","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","68462016305","CARVEDILOL TAB","6.25MG","60","Select","Select",""],["","57894064011","TREMFYA INJ","100MG\/ML","1","Select","Select",""],["","43598043611","NITROGLYCERN SUB","0.4MG","25","Select","Select",""],["","43598057530","TADALAFIL TAB","5MG","30","Select","Select",""],["","29033003206","METFORMIN ER TAB","1000MG","90","Select","Select",""],["","67877041305","METFORMIN TAB","500MG ER","60","Select","Select",""],["","00536132213","OMEPRAZOLE TAB","20MG DR","90","Select","Select",""],["","55111032001","GLIMEPIRIDE TAB","1MG","30","Select","Select",""],["","00078065920","ENTRESTO TAB","24-26MG","60","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","45802014167","CICLOPIROX SOL","8%","7","Select","Select",""],["","65862007930","TERBINAFINE TAB","250MG","90","Select","Select",""],["","00378808345","TRETINOIN","0.05 %","45","Select","Select",""],["","45802006405","TRIAMCINOLONE ACETONIDE","0.1 %","454","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":""}]}]}