{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LYNDA  G BENSON","gend":1,"add":"916 FOREST LAKE CT APT 201","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1955-02-01","age":"","mstatus":"","insh":"20065211*01","cliId":"","pno":8286418539,"cno":8286418539,"email":"","ename":"","eno":"","pphy":"BOLDEN, KELLE D MD","ppno":7575941803,"pcpadd":"STE 140 11803 JEFFERSON AVE,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575109223,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z22.7","M47.812","M54.2","G35.","H53.8","R76.12","M25.78","M48.02","M47.814","F25.9","I10.","E78.00","R73.03","E89.0","Z91.81","Z12.31","Z79.899","G43.009","M50.90","G56.00","R20.0","R20.2","Z79.891","R31.21","R51.9","E66.9","Z68.29","Z87.891","Z88.8","G62.9","R90.82","F12.90","E55.9","Z76.89"],"date":["2022-06-21","2023-01-04","2023-01-04","2023-06-16","2023-04-24","2022-02-10","2022-09-13","2022-09-13","2022-09-13","2023-06-16","2023-06-16","2023-06-16","2023-06-16","2023-06-16","2023-06-16","2022-10-10","2022-04-11","2022-07-11","2022-10-24","2022-10-24","2022-11-03","2022-11-03","2021-01-04","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-07-11","2022-07-11","2023-06-16","2023-06-16","2023-06-16"],"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":[["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","16714025801","AMITRIPTYLINE HCL","25 MG","30","Select","Select",""],["","68645059354","LISINOPRIL","40 MG","30","Select","Select",""],["","42571012290","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","30","Select","Select",""],["","00832105415","BACLOFEN","10 MG","90","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","60","Select","Select",""],["","33342008741","RIZATRIPTAN","5 MG","3","Select","Select",""],["","16571082201","LORATADINE","10 MG","30","Select","Select",""],["","50228018010","GABAPENTIN","300 MG","90","Select","Select",""],["","16729045215","LEVOTHYROXINE SODIUM","112 MCG","90","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST ","8","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","30","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","49035061246","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","90","Select","Select",""],["","00555007102","ISONIAZID","TAB 300MG","12","Select","Select",""],["","00088210224","PRIFTIN","TAB 150MG","24","Select","Select",""],["","30768012587","VITAMIN B-6","TAB 50MG","30","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16729045215","LEVOTHYROXIN","TAB 112MCG","90","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF","CAP ","30","Select","Select",""],["","72305011230","EUTHYROX","TAB 112MCG","90","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","30","Select","Select",""],["","50228018010","GABAPENTIN CAP","300MG","90","Select","Select",""],["","59267100002","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","68645059354","LISINOPRIL TAB","40MG","30","Select","Select",""],["","16571082201","LORATADINE TAB","10MG","30","Select","Select",""],["","68382005005","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN TAB","25MG","90","Select","Select",""],["","49035061246","ALLERGY RELF TAB","10MG","30","Select","Select",""],["","00088210224","PRIFTIN TAB","150MG","24","Select","Select",""],["","00832105415","BACLOFEN TAB","10MG","90","Select","Select",""],["","00093505898","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","30768012587","VITAMIN B-","6 TAB 50MG","30","Select","Select",""],["","00555007102","ISONIAZID TAB","300MG","12","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","60","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF CAP","","30","Select","Select",""],["","33342008741","RIZATRIPTAN TAB","5MG","3","Select","Select",""],["","68645051054","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","16729045215","LEVOTHYROXIN TAB","112MCG","90","Select","Select",""],["","42571012290","LEVOCETIRIZI TAB","5MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","72305011230","EUTHYROX TAB","112MCG","90","Select","Select",""],["","53191036201","D","3-50 1250 MCG","4","Select","Select",""],["","80681017400","VITAMIN D","3 1250 MCG","12","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":""}]}]}