{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARRIE CHAPMAN - LEVIT","gend":1,"add":"123 ST JAMES AVE","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1976-12-23","age":"","mstatus":"","insh":"20050634*01","cliId":"","pno":9175325574,"cno":9175325574,"email":"","ename":"","eno":"","pphy":"SPAK, DARYL J MD","ppno":7579838650,"pcpadd":"2760 GODWIN BLVD STE 100,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine & Walk-In - Suffolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579838673,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","F33.1","F10.239","K70.10","NO DATA","F41.9","F33.9","F10.20","F10.21","D69.6","D61.818","F32.81","Z30.011","S20.212A","Z00.00","L70.0","J30.9","N92.6","Z13.220","Z13.1","Z12.31","Z12.11","F10.10","S06.5X9A","F19.10","Z86.79","D64.9","F41.1","Z72.0","Z20.822","E43.","F10.229","R56.9","Z68.1","R74.8","S00.83XA","E87.6","Z81.8","Z82.49","Z87.891","Z88.5","Z88.0","N92.1","N93.9","F19.239","R53.83","R94.31","E87.3","E87.1","R10.13","R11.2","I10.","Z87.19","Z09.","R14.0","B34.9","F10.920","F10.230","F10.221","F10.231","Z86.39","Z79.899","Z88.2","S09.90XA","S05.12XA","R11.11","W19.XXXA","F11.20","F17.290","Z63.72","Z80.0","Z85.828","Z23."],"date":["2021-03-01","2023-03-14","2022-07-29","2022-08-16","2023-07-27","2023-01-23","2022-07-28","2022-08-16","2023-01-23","2022-08-29","2023-01-23","2022-07-29","2021-07-13","2022-02-03","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-04-22","2022-07-15","2022-08-16","2022-08-16","2023-01-23","2022-08-16","2022-08-16","2022-07-29","2022-07-24","2022-07-24","2022-07-24","2022-07-24","2022-07-24","2022-07-24","2022-07-24","2022-07-29","2022-07-29","2022-07-24","2022-07-24","2022-07-24","2022-04-25","2022-04-25","2022-07-30","2021-01-17","2022-07-24","2021-03-21","2021-03-20","2021-08-13","2022-06-29","2022-07-30","2022-04-22","2022-08-12","2021-03-29","2021-06-03","2022-06-29","2022-06-29","2021-03-20","2021-03-20","2021-03-20","2022-07-29","2021-03-20","2022-06-29","2022-06-29","2022-06-29","2022-06-29","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2023-01-23"],"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":[["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00597003134","CATAPRES-TTS","DIS 0.1\/24HR","4","Select","Select",""],["","65862052301","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","42037010304","BEANO","TAB ","100","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","62756018388","OXCARBAZEPIN","TAB 150MG","75","Select","Select",""],["","00187516245","RETIN-A","CRE 0.0005","45","Select","Select",""],["","29300014901","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","51672139409","TRETINOIN","CRE 0.0005","45","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","1200","Select","Select",""],["","70700026330","LANSOPRAZOLE","CAP 30MG DR","30","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","68462043518","ACAMPRO CAL","TAB 333MG","60","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","33342020010","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","68462064693","ASHLYNA","TAB ","91","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","30","Select","Select",""],["","51285008787","SEASONIQUE","TAB ","91","Select","Select",""],["","00378728153","LEVONOR\/ETHI","TAB ESTRADIO","91","Select","Select",""],["","00555912366","JOLESSA","TAB ","91","Select","Select",""],["","51293084610","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","28","Select","Select",""],["","47335032688","NALTREXONE","TAB 50MG","30","Select","Select",""],["","00093313482","CAMRESE","TAB ","91","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","62135043230","DISULFIRAM","500 MG","30","Select","Select",""],["","68180035206","SERTRALINE","TAB 50MG","60","Select","Select",""],["","10006073021","VITAMIN B1","TAB 100MG","30","Select","Select",""],["","37864000052","THERA-M","TAB ","30","Select","Select",""],["","43598044874","NICOTINE TD","DIS 21MG\/24H","14","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","57896060101","THERA-TABS","TAB ","30","Select","Select",""],["","80681006400","THEREMS","TAB MULTIVIT","30","Select","Select",""],["","80681014202","CERTAVITE\/","TAB ANTIOXID","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","43598044870","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","00904759161","FERROUS SULFATE","325(65) MG","30","Select","Select",""],["","29300046805","CLONIDINE HCL","0.1 MG","90","Select","Select",""],["","68180035209","SERTRALINE HCL","50 MG","45","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","90","Select","Select",""],["","62756018388","OXCARBAZEPIN TAB","150MG","75","Select","Select",""],["","67877032105","IBUPROFEN TAB","800MG","30","Select","Select",""],["","33342020010","LEVOCETIRIZI TAB","5MG","30","Select","Select",""],["","29300046805","CLONIDINE TAB","0.1MG","30","Select","Select",""],["","68462064693","ASHLYNA TAB","","91","Select","Select",""],["","00378728153","LEVONOR\/ETHI TAB ESTRADIO","","91","Select","Select",""],["","00093313482","CAMRESE TAB","","91","Select","Select",""],["","51285008787","SEASONIQUE TAB","","91","Select","Select",""],["","00555912366","JOLESSA TAB","","91","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","20","Select","Select",""],["","00555015902","CHLORDIAZEP CAP","25MG","30","Select","Select",""],["","68462043518","ACAMPRO CAL TAB","333MG","60","Select","Select",""],["","68180035206","SERTRALINE TAB","50MG","60","Select","Select",""],["","10006073021","VITAMIN B","1 TAB 100MG","30","Select","Select",""],["","47335032688","NALTREXONE TAB","50MG","30","Select","Select",""],["","23155050110","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","65162036111","FOLIC ACID TAB","1MG","3","Select","Select",""],["","51672139409","TRETINOIN CRE","0.05%","45","Select","Select",""],["","80681006400","THEREMS TAB MULTIVIT","","30","Select","Select",""],["","43598044874","NICOTINE TD DIS","21MG\/24H","14","Select","Select",""],["","65862052301","GABAPENTIN TAB","600MG","90","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","30","Select","Select",""],["","80681009800","VITAMIN B-","1 TAB 100MG","30","Select","Select",""],["","80681014202","CERTAVITE\/ TAB ANTIOXID","","30","Select","Select",""],["","62135043230","DISULFIRAM TAB","500MG","30","Select","Select",""],["","37864000052","THERA-M TAB","","30","Select","Select",""],["","80777028299","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","57896060101","THERA-TABS TAB","","30","Select","Select",""],["","71093014105","METHOCARBAM TAB","750MG","28","Select","Select",""],["","64380071206","BENZONATATE CAP","100MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","2","Select","Select",""],["","69367017401","HYDROQUINONE","4 %","56.7","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":""}]}]}