{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARA L WALTERS WEST","gend":1,"add":"102 TYLER AVE APT 2A","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1967-12-01","age":"","mstatus":"","insh":"20037159*01","cliId":"","pno":5714069320,"cno":5714069320,"email":"","ename":"","eno":"","pphy":"MURDY, BRIANNA J PA","ppno":7575941850,"pcpadd":"11803 JEFFERSON AVE STE 100,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575941841,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G90.522","M79.672","G89.29","S50.11XA","S60.011A","V58.89","S39.92XA","NO DATA","N39.0","B96.89","F41.0","N39.3","R39.81","N31.9","S40.022A","E66.01","Z79.899","Z98.84","M54.9","M25.562","N95.1","Z98.890","U07.1","F41.1","F33.1","M17.12","R50.9","R05.9","Z20.822","R05.","M54.5","E66.9","Z87.442","R10.12","R19.7","Z12.31","Z12.11","Z13.1","Z13.220","Z53.20","Z76.0","Z68.42","J20.9","J01.80","R10.84","G89.4","F54.","M79.7","G47.9","M79.644","M54.41","I10.","R10.9","J45.909","R10.33","Z87.19","R19.8","K58.9","M19.90","Z63.4"],"date":["2022-07-19","2021-04-15","2021-11-21","2021-05-10","2021-09-28","2022-05-25","2022-05-29","2022-05-29","2023-06-27","2023-04-24","2023-09-11","2021-09-19","2021-09-19","2021-09-19","2022-05-29","2022-07-19","2023-09-11","2023-08-28","2022-05-29","2023-01-11","2021-01-05","2021-04-15","2022-08-30","2023-04-25","2023-09-11","2023-01-11","2022-12-09","2022-06-30","2022-06-30","2021-02-10","2021-02-10","2023-08-28","2021-11-21","2022-07-19","2022-12-09","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2023-04-24","2023-04-24","2023-06-27","2021-07-16","2021-07-16","2022-12-09","2021-09-28","2021-09-28","2022-06-08","2022-06-08","2023-08-22","2023-08-28","2023-08-28","2023-08-22","2023-08-28","2023-08-28","2023-08-28","2023-09-11"],"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":[["","67877024801","QUETIAPINE TAB","400MG","60","Select","Select",""],["","70700016201","PROGESTERONE CAP","100MG","30","Select","Select",""],["","65862069790","VENLAFAXINE CAP","150MG ER","30","Select","Select",""],["","65862016001","ZOLPIDEM TAB","10MG","30","Select","Select",""],["","00093321205","CLONAZEPAM TAB","1MG","90","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","Select","Select",""],["","00555088602","ESTRADIOL TAB","1MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","69097015807","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","10","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","75826010700","DIPHEN\/ATROP TAB","2.5MG","20","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","71093014005","METHOCARBAM TAB","500MG","12","Select","Select",""],["","50383077504","LIDOCAINE SOL","2% VISC","100","Select","Select",""],["","62756052269","SUMATRIPTAN TAB","100MG","9","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00121092616","PROMETH VC SYP","6.25-5\/5","40","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","30","Select","Select",""],["","00093031101","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","30","Select","Select",""],["","75826011510","PHENAZOPYRID TAB","200MG","6","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","20","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","30","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE","10 MG","30","Select","Select",""],["","67877024801","QUETIAPINE FUMARATE","400 MG","60","Select","Select",""],["","00093031101","LOPERAMIDE","2 MG","30","Select","Select",""],["","65862069790","VENLAFAXINE HCL ER","150 MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","29300046810","CLONIDINE HCL","0.1 MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","28","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","30","Select","Select",""],["","65862049501","QUETIAPINE","TAB 400MG","45","Select","Select",""],["","70700016201","PROGESTERONE","CAP 100MG","30","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","65862016001","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","12","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","75826010700","DIPHEN\/ATROP","TAB 2.5MG","20","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00121092616","PROMETH VC","SYP 6.25-5\/5","40","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","50428057834","PAIN RELIEF","4 %","30","Select","Select",""],["","00536132701","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","8","Select","Select",""],["","29300041510","CYCLOBENZAPRINE HCL","10 MG","45","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","30","Select","Select",""],["","00363010412","PAIN RELIEVER","325 MG","30","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":""}]}]}