{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GORDON R SELLERS","gend":0,"add":"1561 CAMPOSTELLA RD LOT 125","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1962-05-06","age":"","mstatus":"","insh":"20034731*01","cliId":"","pno":7574013977,"cno":7574013977,"email":"","ename":"","eno":"","pphy":"ISMAELI-CAMPBELL, ATTIYAH MD","ppno":7579831777,"pcpadd":"213 RIVER WALK PKWY STE 101,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Riverwalk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079043,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","M46.1","R82.90","I10.","D72.829","K31.9","Z76.0","I71.4","R10.13","D50.0","K92.0","M51.36","M48.062","M54.16","J40.","Z20.828","M51.16","M96.1","G89.4","Z96.82","D50.8","F17.208","R11.2","D50.9","R06.81","T40.1X4A","K92.2","N17.9","Z87.898","R55.","F41.1","Z01.818","Z09.","A53.0","R29.898","F19.20","NO DATA","K29.70","K31.89","K21.9","Z86.010","Z20.822","D62.","G93.40","B19.20","G89.29","E86.0","F11.10","M54.9","I95.9","Z72.0","D56.1","R41.89","T40.601A","T48.901A","Z00.00","H61.92","F17.200","R71.8","Z12.5","N40.0","R10.9","Z79.899","K59.00","R56.9","R10.31","R19.8","R11.0","R19.7","K76.0","M19.90","Z86.79","Z87.11","F17.210","Z88.6","Z83.3","Z82.49","Z82.3","R09.2"],"date":["2023-04-11","2023-07-05","2021-09-08","2023-07-29","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2022-09-09","2022-09-09","2023-07-05","2021-07-02","2022-02-21","2023-07-05","2021-10-10","2022-02-14","2022-02-14","2022-02-01","2022-02-14","2021-03-11","2021-06-24","2022-02-02","2022-03-31","2022-02-02","2023-09-21","2022-02-03","2022-03-31","2022-02-03","2023-05-10","2021-11-03","2022-02-21","2022-03-31","2022-03-31","2022-03-31","2022-03-31","2023-07-05","2022-02-03","2022-02-03","2023-08-02","2023-08-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2023-07-29","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2021-03-11","2023-05-10","2023-09-21","2023-05-10","2023-07-05","2023-07-05","2023-08-02","2023-07-05","2023-07-05","2023-07-29","2023-08-02","2023-07-29","2023-06-25","2023-06-25","2023-07-29","2023-08-02","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-07-29","2023-09-21"],"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":[["","68382050010","OMEPRAZOLE","40 MG","90","Select","Select",""],["","70700026390","LANSOPRAZOLE","CAP 30MG DR","60","Select","Select",""],["","00378668899","PANTOPRAZOLE","TAB 20MG","60","Select","Select",""],["","00904674860","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","65162075450","BENAZEPRIL","TAB 40MG","90","Select","Select",""],["","29300033301","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","31722052530","FINASTERIDE","TAB 5MG","90","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","21","Select","Select",""],["","42806071401","BENZONATATE","100 MG","30","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","16","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","6","Select","Select",""],["","00363089653","NICOTINE TD","DIS 21MG\/24H","7","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","60","Select","Select",""],["","65862011801","BENAZEPRIL HCL","40 MG","90","Select","Select",""],["","00378113401","KETOROLAC TROMETHAMINE","10 MG","20","Select","Select",""],["","65162062711","TRAMADOL HCL","50 MG","20","Select","Select",""],["","70954068910","PROCHLORPERAZINE MALEATE","10 MG","20","Select","Select",""],["","00093319601","CEFADROXIL","500 MG","20","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","4","Select","Select",""],["","00093224001","CEPHALEXIN TAB","500MG","6","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","00536589653","NICOTINE TD DIS","21MG\/24H","7","Select","Select",""],["","65162075450","BENAZEPRIL TAB","40MG","90","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","300","Select","Select",""],["","65162010250","GABAPENTIN CAP","300MG","60","Select","Select",""],["","00527128201","DICYCLOMINE HCL","20 MG","120","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","81421002001","DULCOLAX","5 MG","4","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":""}]}]}