{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE BUTLER","gend":1,"add":"2709 AZALEA GARDEN RD APT B4","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1970-04-03","age":"","mstatus":"","insh":"20050513*01","cliId":"","pno":7572868553,"cno":7572868553,"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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.11","M62.838","F69.","V62.84","F19.10","F25.0","F14.20","F19.951","F20.9","G44.89","F80.81","F41.9","N28.1","R07.9","R10.13","Z87.891","F20.0","R47.81","J06.9","R49.0","J45.20","M54.2","M54.6","N62.","K08.89","F25.1","G89.29","F32.2","F43.10","R10.9","S83.242A","M25.562","R10.84","Z82.49","Z91.018","M25.561","F33.3","S09.90XA","R55.","F43.12","F41.1","S00.01XA","F12.90","I10.","F98.5","R41.9","J45.909","K21.9","G43.909","R51.9","Z09.","R23.2","NO DATA","M62.830","F14.10","A53.0","Z12.31","Z12.11","M25.461","F17.210","Z98.890","M25.551","M79.644","J45.40"],"date":["2021-06-15","2021-06-15","2022-03-05","2022-03-05","2022-03-05","2022-03-22","2022-03-22","2023-08-31","2023-01-05","2021-12-12","2021-12-19","2021-12-19","2023-03-27","2021-11-30","2021-02-08","2023-06-28","2021-07-06","2021-12-19","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2023-08-31","2023-08-31","2021-02-17","2021-02-17","2021-05-13","2021-11-02","2023-08-31","2021-05-13","2021-12-19","2023-01-23","2023-01-23","2021-01-31","2021-12-12","2021-12-12","2021-01-29","2021-01-29","2021-12-12","2021-12-12","2021-12-12","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2023-08-31","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2023-08-31","2023-08-31","2023-01-23","2023-01-23","2023-01-23","2021-06-15","2023-06-28","2023-08-31"],"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":[["","65162046650","IBUPROFEN","800 MG","30","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","24","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","47335070352","ALBUTEROL","NEB 0.00083","90","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","29300015001","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","68180035206","SERTRALINE","TAB 50MG","30","Select","Select",""],["","66993007896","FLUTICAS HFA","AER 44MCG","11","Select","Select",""],["","00173071820","FLOVENT HFA","44 MCG","10.6","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","47335070352","ALBUTEROL SULFATE","2.5 MG\/3ML","90","Select","Select",""],["","70461032103","FLUCLVX QUAD INJ","2021-22","0","Select","Select",""],["","68180035206","SERTRALINE TAB","50MG","30","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","400","Select","Select",""],["","29300015001","QUETIAPINE TAB","200MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","47335070352","ALBUTEROL NEB","0.083%","90","Select","Select",""],["","00173071820","FLOVENT HFA AER","44MCG","11","Select","Select",""],["","66993007896","FLUTICAS HFA AER","44MCG","11","Select","Select",""],["","64380071206","BENZONATATE CAP","100MG","30","Select","Select",""],["","00093310953","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","60","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","66993007896","FLUTICASONE PROPIONATE HFA","44 MCG","10.6","Select","Select",""],["","08373053000","HOME NEBULIZER PLUS SIDESTREAM","","1","Select","Select",""],["","68180044701","QUETIAPINE FUMARATE","100 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":""}]}]}