{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RODNEY J JACKSON","gend":0,"add":"104 N WITCHDUCK ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23504-9998","dob":"1980-07-31","age":"","mstatus":"","insh":"20061583*01","cliId":"","pno":7572818169,"cno":7572818169,"email":"","ename":"","eno":"","pphy":"NELSON, MERRILYN E DO","ppno":7573951300,"pcpadd":"2859 VIRGINIA BEACH BLVD,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572260247,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","F43.12","F10.20","F31.81","S90.31XA","Z87.891","T16.1XXA","F39.","Z59.00","J45.30","R71.8","F31.62","Z11.3","F90.0","Z20.2","Z59.0","F10.21","Z59.2","Z56.0","J30.9","J45.909","R53.83","E61.1","Z12.5","M79.675","M54.5","M79.674","G89.29","Z20.828","T16.9XXA","Z21.","Z79.1","Z91.09","Z53.21","H92.01","F10.239","F14.10","F12.10","F20.9","Z59.01","Z62.810","F17.210","T14.90XA","J45.901","B34.9","Z48.02","S61.213A","J02.9","S50.812A"],"date":["2023-06-27","2023-06-27","2023-06-27","2021-11-01","2021-09-13","2022-08-05","2021-10-24","2022-02-25","2022-08-26","2022-10-19","2022-02-25","2022-08-26","2022-02-25","2022-08-30","2022-08-05","2021-08-18","2022-03-15","2023-06-27","2023-06-27","2021-11-02","2021-11-02","2021-11-02","2022-08-26","2022-08-26","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-03-17","2021-10-24","2022-08-05","2022-08-05","2022-08-05","2022-11-10","2021-10-24","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2023-09-15","2023-05-30","2023-05-30","2023-06-12","2023-05-31","2023-05-30","2023-09-15"],"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":[["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","180","Select","Select",""],["","29300014801","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","63629338701","ABILIFY","TAB 5MG","30","Select","Select",""],["","31722082030","ARIPIPRAZOLE","5 MG","30","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","14","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","00173089310","TRELEGY","AER 200MCG","60","Select","Select",""],["","00904625549","SORE THROAT","LOZ 15-3.6MG","28","Select","Select",""],["","63824071316","CEPACOL SORE","LOZ 15-3.6MG","16","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","30","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","00406117003","NALTREXONE HCL","50 MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","65862049001","QUETIAPINE TAB","50MG","30","Select","Select",""],["","00093506101","HYDROXYZ HCL TAB","25MG","180","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","16729008110","NALTREXONE TAB","50MG","30","Select","Select",""],["","43547030303","ARIPIPRAZOLE TAB","5MG","30","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","00173089310","TRELEGY AER","200MCG","60","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","90","Select","Select",""],["","70312046129","SORE THROAT LOZ","15-3.6MG","18","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","63824071016","CEPACOL SORE LOZ","15-3.6MG","28","Select","Select",""],["","65162046550","IBUPROFEN TAB","600MG","21","Select","Select",""],["","57237002801","AMOXICILLIN TAB","500MG","21","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","00093751831","FLUTICASONE-SALMETEROL","250-50 MCG","60","Select","Select",""],["","51672404801","CLOTRIMAZOLE-BETAMETHASONE","1 %-0.05 %","30","Select","Select",""],["","00378932132","WIXELA INHUB","250-50 MCG","60","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00378064205","PREDNISONE","20 MG","12","Select","Select",""],["","65757030001","VIVITROL","380 MG","1","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":""}]}]}