{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER  M DIAZ","gend":1,"add":"1621 BROADFIELD RD APT 3C","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1975-09-16","age":"","mstatus":"","insh":"20038729*01","cliId":"","pno":8044976165,"cno":8044976165,"email":"","ename":"","eno":"","pphy":"WARE, JENNIFER L MD","ppno":7573889925,"pcpadd":"7401 GRANBY ST","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579658519,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","N18.5","M54.2","M70.22","R07.9","R42.","Z59.00","R10.9","E83.52","N18.4","R22.1","F12.10","N18.6","Z99.2","F17.210","F20.9","Z79.899","Z91.51","Z91.14","N30.00","Z04.41","F23.","N18.9","F31.9","R00.0","Z86.2","Z76.0","F31.64","D64.9","L02.31","Z91.15","R82.90","Z11.59","Z11.4","R56.9","F14.10","B00.9","Z88.0","T76.21XA","F19.10","F25.9","G89.29","M54.9","Z23.","M79.672","M25.562","M25.522","R51.9","V04.90XA","F09.","Z11.3","E50.1","H04.123","F20.0","M25.512","M25.532","F10.929","N17.9","F10.120","N39.0","I49.3","E83.39","Z83.3","Z81.8","Z83.438","Z98.82","F40.240","NO DATA","F20.3","F31.31","F31.5","M25.272","Z30.013","K62.89","Z01.419","Z12.39","Z12.4","Z11.51","T74.21XS","Z30.09","R11.11","H81.10","N30.01","Z86.59","L05.01","R22.2","Z20.822","Z30.42","R69.","T14.90XA","T74.21XA","N89.8","N10.","R53.1","F22.","L29.9","R26.2","L91.0","B20.","Z88.1","Z87.891","N20.0","R30.0","Z51.89","F31.2","Z68.23"],"date":["2023-01-05","2021-12-02","2022-11-04","2021-12-02","2022-05-21","2022-07-18","2022-05-21","2022-05-21","2023-01-05","2023-01-05","2023-01-05","2022-08-30","2022-11-04","2022-11-04","2022-11-04","2023-03-01","2022-11-04","2022-11-04","2022-11-04","2023-03-01","2021-08-17","2021-09-24","2022-03-16","2022-08-26","2022-03-16","2022-03-16","2022-03-16","2022-05-12","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2021-08-15","2021-08-15","2021-09-12","2021-08-17","2022-08-26","2021-11-05","2021-11-05","2022-02-17","2021-03-20","2021-03-20","2021-11-05","2021-03-20","2021-03-20","2021-05-14","2021-09-15","2021-05-27","2021-05-27","2021-10-20","2021-11-05","2021-11-05","2022-08-21","2022-08-26","2022-08-26","2023-03-01","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2023-01-05","2022-04-06","2022-04-06","2021-05-13","2021-03-20","2021-06-14","2021-08-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-10-05","2021-03-23","2021-09-12","2021-09-12","2022-01-22","2022-11-21","2022-11-21","2021-07-28","2021-03-20","2021-03-20","2021-09-12","2021-09-12","2021-10-05","2021-10-05","2022-05-11","2022-05-11","2022-07-18","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2021-10-05","2021-10-05","2022-01-24","2022-04-11","2022-04-11"],"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":[["","33342006807","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","43598056601","FLUOXETINE","TAB 20MG","30","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","10","Select","Select",""],["","16571066001","MECLIZINE","TAB 12.5MG","20","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","24357070130","ANECREAM","CRE 0.04","60","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","90","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","00005197102","PREVNAR 13","INJ ","0","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","11509000367","VAGISIL","CRE ","28","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","23155022801","ACYCLOVIR","TAB 800MG","6","Select","Select",""],["","58160081552","TWINRIX","INJ ","1","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","20","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","69238110005","DOXYCYCLINE HYCLATE","100 MG","28","Select","Select",""],["","57664037718","TRAMADOL HCL","50 MG","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":""}]}]}