{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDY  A FOBBS","gend":1,"add":"515 WILLOWBRIDGE CT APT 4","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1964-07-17","age":"","mstatus":"","insh":"20064093*01","cliId":"","pno":7578007047,"cno":7578007047,"email":"","ename":"","eno":"","pphy":"ALBALA, NATALIE L MD","ppno":7573956630,"pcpadd":"1080 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - 1080 Bldg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079074,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","M05.79","K92.1","R14.0","NO DATA","I10.","M05.89","Z87.891","Z79.82","Z79.899","D17.9","M79.609","M15.9","D84.9","R07.89","R00.2","J90.","R31.0","Z23.","F17.200","M05.9","G47.33","Z79.52","Z68.35","I51.7","Z01.810","R06.02","M25.561","M25.562","Z00.00","Z68.36","R91.1","Z12.31","Z12.4","Z12.11","E83.52","I27.20","R60.0","G47.31","M67.432","D17.21","Z01.818","J84.9","E21.3","E66.01","R73.9","Z78.9","F17.210","Z68.41","M17.0","J44.9","R22.32","Z01.811","Z01.812","R94.31","E87.6","Z86.39","E66.9","Z68.34","M06.89","K92.0","E55.9","Z13.820","M81.0","M06.9","Z68.37","R29.818","I36.1","Z76.89","A59.9","G62.9","M25.512","M79.602","G89.29","R31.21","Z79.1","K59.00","Z53.09","R07.9","E78.2","R91.8","I28.8","Z77.098","R22.31","Z68.33","R19.5","I08.1","K62.5","M79.606","M79.604","R77.8","M79.89","I49.9","Z13.9","Z13.31","I50.9","R22.43","M19.90"],"date":["2023-04-17","2023-04-05","2022-09-22","2022-09-22","2023-01-09","2023-03-29","2022-09-22","2022-09-22","2023-01-20","2023-01-20","2022-11-21","2023-02-03","2023-04-05","2023-04-05","2021-01-02","2021-02-10","2021-02-10","2021-09-10","2021-09-10","2021-09-10","2022-05-04","2023-03-29","2023-01-20","2021-09-10","2022-08-23","2022-12-23","2022-02-24","2022-04-25","2022-08-20","2022-08-23","2021-01-04","2021-05-04","2022-06-08","2022-06-08","2022-09-22","2021-05-04","2021-07-23","2023-03-29","2021-08-22","2022-01-13","2023-01-20","2023-01-17","2023-01-09","2022-02-04","2022-06-08","2022-08-23","2022-08-23","2023-01-20","2022-04-13","2022-11-15","2022-02-25","2022-10-27","2022-12-23","2022-12-23","2022-12-23","2023-01-17","2023-01-17","2023-01-20","2023-04-18","2023-01-20","2022-09-22","2021-04-01","2021-04-01","2021-04-01","2023-03-29","2021-08-22","2021-08-22","2022-02-24","2021-04-19","2022-07-08","2022-07-08","2022-08-20","2022-08-20","2022-08-20","2022-08-20","2022-08-20","2022-09-22","2022-09-22","2022-11-14","2022-11-14","2021-01-26","2021-01-26","2021-01-26","2021-05-04","2022-08-23","2022-09-08","2021-02-10","2022-09-08","2023-01-09","2023-02-03","2023-03-29","2023-04-18","2023-03-29","2023-04-18","2023-04-18","2023-03-29","2023-03-29","2023-03-29"],"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":[["","16714085201","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00054455015","METHOTREXATE","2.5 MG","40","Select","Select",""],["","59746017306","PREDNISONE","10 MG","60","Select","Select",""],["","11534016501","FOLIC ACID","1 MG","30","Select","Select",""],["","11822061676","RA NICOTINE","GUM 4MG MINT","40","Select","Select",""],["","00054429731","FUROSEMIDE","20 MG","90","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","180","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00074055402","HUMIRA PEN","INJ 40\/0.4ML","2","Select","Select",""],["","10572001201","SODIUM\/POTAS","SOL MAGNESIU","354","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","354","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","1","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","58406003204","ENBREL SRCLK","INJ 50MG\/ML","4","Select","Select",""],["","00074230630","RINVOQ","TAB 15MG ER","30","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","00074055402","HUMIRA(CF) PEN","40MG\/0.4ML","2","Select","Select",""],["","58406003204","ENBREL SURECLICK","50MG\/ML(1)","4","Select","Select",""],["","72516003001","METOPROLOL SUCCINATE","25 MG","3","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","29300046805","CLONIDINE HCL","0.1 MG","9","Select","Select",""],["","11822365670","ACETAMINOPHEN","500 MG","60","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":""}]}]}