{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIRK   L JONES","gend":0,"add":"106 FORT WORTH ST","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1968-02-27","age":"","mstatus":"","insh":"20030281*01","cliId":"","pno":7574638074,"cno":7574638074,"email":"","ename":"","eno":"","pphy":"EMECHEBE, NONSO 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":["F10.20","E11.69","Z23.","E11.65","Z12.5","F17.200","E75.6","Z79.4","E11.9","E11.59","E78.5","I15.2","F25.0","V62.84","F10.920","R73.9","I10.","NO DATA","V62.89","F14.10","H35.361","H25.813","B35.1","B35.3","F31.9","F17.210","Z83.3","I48.0","M20.11","M20.12","L30.9","R23.4","M20.41","M20.42","M21.6X1","M21.6X2","E55.9","Z13.220","Z20.828","E66.01","E88.81","Z91.14","Z79.82","Z79.899","Z86.010","Z68.35","Z91.11","F31.62","D64.9","F17.219","F14.20","E11.42","F19.10","Z11.59"],"date":["2022-01-03","2023-01-30","2022-07-18","2023-02-23","2022-11-18","2022-11-18","2023-01-25","2023-02-23","2023-01-30","2023-01-30","2023-01-30","2023-01-30","2023-01-25","2021-04-11","2022-06-25","2021-04-11","2022-06-25","2022-06-25","2021-06-15","2021-06-15","2021-11-24","2021-11-24","2021-12-01","2021-12-01","2022-06-25","2022-06-25","2022-06-25","2023-01-25","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2022-07-18","2021-12-20","2021-02-14","2023-01-25","2021-06-12","2021-06-12","2021-06-12","2021-06-12","2021-06-12","2021-06-12","2021-06-12","2021-06-17","2021-09-21","2021-06-17","2022-01-31","2021-09-21","2021-03-11","2021-03-11"],"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":[["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","79854020096","B-100 COMP","TAB TR","90","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","80681000900","VITAMIN D3","CAP 50MCG","90","Select","Select",""],["","00002751101","HUMALOG MIX","SUS 75\/25","60","Select","Select",""],["","60505265901","TRAZODONE","TAB 300MG","30","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","50742025090","DILTIAZEM","24HR ER (CD) 240 MG","90","Select","Select",""],["","61874013030","VRAYLAR","3 MG","30","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","60","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","65862086001","FAMOTIDINE","40 MG","90","Select","Select",""],["","00169368512","NOVOLOG MIX","70-30 70-30\/ML","60","Select","Select",""],["","00378425001","DOXEPIN HCL","CAP 50MG","14","Select","Select",""],["","43598044874","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","33342005615","PIOGLITAZONE","TAB 45MG","30","Select","Select",""],["","59779044870","CVS NICOTINE","DIS 21MG\/24H","30","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","1","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","08290328418","INSULIN SYRG","MIS 1ML\/31G","100","Select","Select",""],["","00169183711","NOVOLIN","INJ 70\/30","90","Select","Select",""],["","45802013811","CICLOPIROX","CRE 0.0077","90","Select","Select",""],["","59779060027","CVS ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","16477034001","UREA","CRE 0.4","28","Select","Select",""],["","00002223680","TRULICITY","INJ 3\/0.5","6","Select","Select",""],["","73070020011","INSULIN ASPA","INJ 70\/30","60","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","49483048112","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","60505265901","TRAZODONE HCL","300 MG","30","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","08290320122","ULTRA-FINE NANO PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","62088000031","INPEN (FOR HUMALOG)","","2","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","30","Select","Select",""],["","67877056310","METFORMIN HCL","1000 MG","180","Select","Select",""],["","73070010011","INSULIN ASPART","100\/ML","50","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","00093727398","PIOGLITAZONE HCL","45 MG","90","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":""}]}]}