{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLENE SIMMONS","gend":1,"add":"105 MONTFORD CT APT 201","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1964-12-29","age":"","mstatus":"","insh":"20065576*01","cliId":"","pno":7574527958,"cno":7574527958,"email":"","ename":"","eno":"","pphy":"STEWART, LEAH A NP","ppno":7573186900,"pcpadd":"2017 PLEASURE HOUSE RD,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23455-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573186901,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G57.62","M76.62","M92.62","M20.12","D86.0","D86.9","R05.","J96.11","R94.2","G47.33","F41.1","R00.2","I50.32","D86.3","Z79.52","D84.9","H30.22","Z96.1","J30.1","M25.561","H43.812","J30.89","R09.81","S83.282A","J44.9","M25.562","S76.219A","Z98.890","M94.9","M23.92","Z48.89","R06.83","G25.81","G47.00","E66.9","G47.8","V54.12","R07.89","Z01.818","V58.89","M22.2X9","F33.1","F41.9","B37.3","M25.552","M25.551","Z12.11","D12.6","K63.5","Z86.010","I10.","J45.909","J96.10","Z68.31","Z87.891","Z90.49","Z88.8","Z88.2","Z79.51","Z79.899","R06.09","R45.4","F33.2","F51.05","M84.345A","R91.1","M79.671","R91.8","H20.9","F32.9","R00.1","Z12.31","M89.9","M76.72","M25.572","M79.672","Z23.","D86.2","R59.1","R93.7","M79.645","R29.6","R42.","M54.9","M54.2","M62.81","M25.661","Z47.89","H00.032","H00.031","R05.9","Z51.81","G89.29","R59.0","K82.8","Z79.891","S83.271A","G57.82","R26.2","Z00.00","E78.5","Z91.81","S83.015A","H04.121","H04.122","Z20.822","M25.362","M23.362","M22.2X2","M94.8X6","M25.569","G47.30","S62.667A","R26.81","Z01.810","R94.31","F32.1","M76.31","R09.02","Z99.81","R06.4","M77.41","M92.60","M51.36","R03.0","M79.604","M22.8X2","M23.8X2","F31.9","R29.898","M22.42","NO DATA","R11.0","S01.112A","R06.02","J20.9","M54.16","F11.20","M22.41","M22.11","R69.","Z96.652","K21.9","K59.09","I50.9","T88.59XA","Z02.89","R21.","S60.052A","M76.32","M23.361","M67.361","S83.281A","M94.261","M67.861","M54.12","M54.5","Z86.2","Z99.89","M23.8X9","M25.461","M25.852","M25.851","M21.062","M24.573","E65.","Z13.29","M77.52","F90.9","J02.9","D86.83","H02.432","H04.123","H10.45","H43.821","M25.511","M25.512","G44.209","M16.0","F90.0","M79.641","R73.09","Z13.820","Z78.0"],"date":["2022-04-29","2021-02-17","2021-02-17","2021-02-17","2023-08-03","2023-08-08","2021-06-22","2023-08-03","2022-06-24","2023-08-08","2023-09-05","2023-04-18","2023-08-10","2023-08-03","2022-05-11","2023-08-03","2023-05-23","2022-08-09","2022-11-02","2021-09-10","2022-08-09","2021-12-16","2021-12-16","2022-01-10","2023-08-05","2022-09-30","2022-04-22","2023-04-14","2022-04-22","2022-09-30","2022-09-30","2022-11-16","2023-08-08","2023-08-08","2023-08-10","2023-02-14","2023-03-22","2023-02-07","2021-12-13","2023-04-14","2021-12-13","2023-03-16","2021-12-13","2021-12-13","2023-07-25","2023-07-25","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2023-08-10","2022-07-20","2022-07-20","2022-07-20","2023-08-06","2022-07-20","2022-12-07","2022-12-07","2022-07-20","2023-05-03","2022-08-05","2023-05-24","2023-09-05","2023-05-24","2022-10-07","2022-10-07","2022-10-07","2023-08-03","2023-08-03","2022-10-20","2023-04-18","2022-11-10","2022-11-10","2022-11-10","2023-04-21","2023-04-21","2023-01-05","2023-04-10","2023-04-10","2023-04-10","2023-02-09","2021-04-23","2022-10-14","2021-02-09","2023-08-06","2021-06-29","2021-06-29","2021-06-11","2021-06-18","2021-06-18","2022-06-24","2023-06-19","2023-05-24","2023-04-03","2022-12-07","2023-06-19","2021-01-12","2023-04-21","2021-06-02","2022-10-14","2022-10-14","2022-10-14","2022-01-06","2022-08-09","2022-08-09","2022-01-03","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-12-15","2022-10-11","2022-10-12","2021-02-11","2021-02-17","2021-02-17","2021-06-28","2021-04-29","2022-08-09","2022-08-09","2022-08-09","2022-10-04","2021-02-17","2021-02-17","2021-02-17","2021-04-23","2022-01-06","2023-04-14","2022-06-01","2022-10-19","2023-04-14","2023-03-01","2022-05-11","2023-05-23","2022-08-09","2022-10-02","2023-09-25","2023-09-25","2021-08-27","2022-01-06","2022-01-13","2022-04-18","2022-09-20","2022-07-14","2022-07-14","2022-07-14","2022-08-03","2022-08-03","2022-09-27","2021-01-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-06-01","2021-02-08","2021-03-05","2021-03-05","2021-04-19","2021-04-19","2022-06-06","2022-06-06","2022-06-06","2022-12-15","2022-12-15","2023-03-16","2023-04-21","2023-04-24","2023-04-24","2023-04-24","2023-05-23","2023-09-13","2023-09-13","2023-06-09","2023-07-25","2023-07-25","2023-08-06","2023-09-25","2023-09-05","2023-08-06","2023-08-10","2023-08-10","2023-08-10"],"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":[["","59746017310","PREDNISONE","10 MG","60","Select","Select",""],["","00228203110","ALPRAZOLAM","1 MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00487950103","ALBUTEROL","NEB 0.00083","1080","Select","Select",""],["","00527143501","METAXALONE","TAB 800MG","30","Select","Select",""],["","67877022505","MYCOPHENOLAT","TAB 500MG","60","Select","Select",""],["","13668033101","TRAZODONE","TAB 100MG","120","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","2","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","43547026810","ROPINIROLE","TAB 0.25MG","60","Select","Select",""],["","13668034030","LAMOTRIGINE","TAB 50MG ER","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","20","Select","Select",""],["","16571068701","HYDROXYCHLOR","TAB 200MG","60","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","60505003306","PENTOXIFYLLI","TAB 400MG ER","60","Select","Select",""],["","43386002606","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","90","Select","Select",""],["","49035023814","EQ STOOL","CAP SOFTENER","20","Select","Select",""],["","00054430129","FUROSEMIDE","80 MG","180","Select","Select",""],["","00536120215","LIDOCAINE PA","PAD 0.04","10","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","46581083006","SALONPAS GEL","PAD 0.04","10","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","60","Select","Select",""],["","60758011910","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","45802002146","BETAMETH DIP","LOT 0.0005","60","Select","Select",""],["","70436001004","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","63004871001","ACTHAR","INJ 80UNIT","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","10","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","17478004101","NALOXONE","INJ 0.4MG\/ML","1","Select","Select",""],["","10370082905","DILTIAZEM","CAP 120MG ER","30","Select","Select",""],["","00603548321","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","60505620202","CYCLOSPORINE","0.05 %","60","Select","Select",""],["","00023916330","RESTASIS","0.05 %","60","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","60","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","13668059502","NYSTATIN","100000\/G","30","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","20","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","28","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","60","Select","Select",""],["","13668034030","LAMOTRIGINE ER","50 MG","30","Select","Select",""],["","00603548321","PROPRANOLOL HCL","20 MG","60","Select","Select",""],["","69452035620","ROPINIROLE HCL","0.25 MG","60","Select","Select",""],["","13107007901","TRAZODONE HCL","50 MG","90","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","67877022505","MYCOPHENOLATE MOFETIL","500 MG","120","Select","Select",""],["","00378827052","ALBUTEROL SULFATE","2.5 MG\/3ML","450","Select","Select",""],["","42806041630","BUPROPION XL","300 MG","39","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","180","Select","Select",""],["","16571068701","HYDROXYCHLOROQUINE SULFATE","200 MG","30","Select","Select",""],["","66993058597","FLUTICASONE-SALMETEROL","250-50 MCG","60","Select","Select",""],["","45802002146","BETAMETHASONE DIPROPIONATE","0.05 %","60","Select","Select",""],["","60758011905","PREDNISOLONE ACETATE","1 %","10","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","59417010210","VYVANSE","20 MG","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00536129901","MECLIZINE HCL","25 MG","30","Select","Select",""],["","50383077504","LIDOCAINE HCL VISCOUS","2 %","480","Select","Select",""],["","67877022505","MYCOPHENOLAT TAB","500MG","60","Select","Select",""],["","00603548321","PROPRANOLOL TAB","20MG","60","Select","Select",""],["","31722017030","DULOXETINE CAP","60MG","60","Select","Select",""],["","13668033101","TRAZODONE TAB","100MG","120","Select","Select",""],["","70436001004","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","13668034030","LAMOTRIGINE TAB","50MG ER","30","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","28","Select","Select",""],["","16571068701","HYDROXYCHLOR TAB","200MG","30","Select","Select",""],["","00228203110","ALPRAZOLAM TAB","1MG","90","Select","Select",""],["","10370082905","DILTIAZEM CAP","120MG ER","30","Select","Select",""],["","45802002146","BETAMETH DIP LOT","0.05%","60","Select","Select",""],["","59746012206","MECLIZINE TAB","12.5MG","30","Select","Select",""],["","00904544861","PENTOXIFYLLI TAB","400MG ER","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","17","Select","Select",""],["","00527143501","METAXALONE TAB","800MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","68382002310","ATENOLOL TAB","50MG","90","Select","Select",""],["","00093026492","FLUOCINONIDE OIN","0.05%","60","Select","Select",""],["","43386002606","FLUOCINONIDE SOL","0.05%","60","Select","Select",""],["","60758011905","PREDNISOLONE SUS","1% OP","10","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","60","Select","Select",""],["","00023916360","RESTASIS EMU","0.05% OP","60","Select","Select",""],["","60505620202","CYCLOSPORINE EMU","0.05% OP","60","Select","Select",""],["","43547026810","ROPINIROLE TAB","0.25MG","60","Select","Select",""],["","00054430129","FUROSEMIDE TAB","80MG","60","Select","Select",""],["","63004871001","ACTHAR INJ","80UNIT","10","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","30","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00254101196","SUCRALFATE SUS","1GM\/10ML","400","Select","Select",""],["","17478007035","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","70000052103","OMEPRAZOLE TAB","20MG DR","60","Select","Select",""],["","00378827052","ALBUTEROL NEB","0.083%","450","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","10","Select","Select",""],["","65162019011","NAPROXEN TAB","500MG","60","Select","Select",""],["","29033000305","SUCRALFATE TAB","1GM","120","Select","Select",""],["","55111014512","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","55111064530","OMEPRAZOLE CAP","40MG","60","Select","Select",""],["","66993058597","FLUTIC\/SALME AER","250\/50","60","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","64380076921","PEG-","3350\/KCL SOL \/SODIUM","4000","Select","Select",""],["","68645051554","AMLODIPINE TAB","5MG","30","Select","Select",""],["","62175061746","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","16571020210","DICLOFENAC TAB","50MG DR","20","Select","Select",""],["","17478004101","NALOXONE INJ","0.4MG\/ML","1","Select","Select",""],["","13668059502","NYSTATIN CRE","100000","30","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","68382078201","DOXYCYCLINE MONOHYDRATE","50 MG","60","Select","Select",""],["","24208058060","GENTAMICIN SULFATE","0.3 %","5","Select","Select",""],["","69238138003","DIFLUPREDNATE","0.05 %","5","Select","Select",""],["","62332049960","DOXYCYCLINE HYCLATE","50 MG","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","00527150537","DEXTROAMPHETAMINE-AMPHETAMINE","20 MG","60","Select","Select",""],["","29300041319","CYCLOBENZAPRINE HCL","5 MG","10","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","00169452514","WEGOVY","0.25MG\/0.5","2","Select","Select",""],["","16571020210","DICLOFENAC SODIUM","50 MG","20","Select","Select",""],["","00169406012","VICTOZA","2-PAK 0.6 MG\/0.1","6","Select","Select",""],["","31722093612","OMEGA-","3 ACID ETHYL ESTERS 1 G","90","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 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":""}]}]}