{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMARA OGAI","gend":1,"add":"714 RALEIGH AVE ALISSA GAVALIAN","city":"NORFOLK","state":"VA","zip":"23507-9998","dob":"1944-01-03","age":"","mstatus":"","insh":"20032884*01","cliId":"","pno":7576516566,"cno":7576516566,"email":"","ename":"","eno":"","pphy":"HARDT, ANTHONY B MD","ppno":7573952500,"pcpadd":"1024 FIRST COLONIAL RD,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - First Colonial","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572759700,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","F41.9","E87.1","Z00.00","E78.2","K13.79","J39.2","R07.0","K59.01","E55.9","R07.1","Z53.21","S29.9XXA","M15.9","M65.331","K21.9","R73.02","R07.9","L02.818","M19.90","K12.0","R07.89","R00.2","R06.02","R79.89","K44.9","K90.0","Z90.49"],"date":["2022-12-01","2021-05-07","2021-05-07","2022-11-23","2022-11-22","2021-12-03","2021-12-03","2021-12-03","2022-11-22","2022-11-22","2022-11-22","2021-05-17","2021-07-19","2021-09-20","2021-09-20","2022-11-23","2022-11-23","2022-11-25","2023-04-13","2021-05-03","2021-11-26","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01"],"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":[["","68180051202","LISINOPRIL","2.5 MG","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68462020130","TELMISARTAN","TAB 80MG","30","Select","Select",""],["","23155002601","VERAPAMIL","TAB 80MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","3","Select","Select",""],["","55111019605","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","67877039130","NEBIVOLOL","TAB 10MG","30","Select","Select",""],["","00456141030","BYSTOLIC","TAB 10MG","30","Select","Select",""],["","00254302902","LUBIPROSTONE","CAP 24MCG","60","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","60","Select","Select",""],["","43547039203","OLM MED\/HCTZ","TAB 40-12.5","90","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00781185220","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","66689000816","NYSTATIN","100000\/ML","200","Select","Select",""],["","68180051201","LISINOPRIL TAB","2.5MG","180","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","90","Select","Select",""],["","00254302902","LUBIPROSTONE CAP","24MCG","60","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","67877039130","NEBIVOLOL TAB","10MG","30","Select","Select",""],["","55111019605","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","68462020130","TELMISARTAN TAB","80MG","30","Select","Select",""],["","23155002601","VERAPAMIL TAB","80MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","3","Select","Select",""],["","64764024060","AMITIZA CAP","24MCG","60","Select","Select",""],["","43547039203","OLM MED\/HCTZ TAB","40-12.5","90","Select","Select",""],["","00456141030","BYSTOLIC TAB","10MG","30","Select","Select",""],["","51672129801","KETOCONAZOLE","2 %","15","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":""}]}]}