{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAZEL  L WALKER","gend":1,"add":"721 CHIMNEY HILL PKWY APT 317","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1959-10-15","age":"","mstatus":"","insh":"20067737*01","cliId":"","pno":7577011164,"cno":7577011164,"email":"","ename":"","eno":"","pphy":"ROBLEDO, ELIZABETH MD","ppno":7573951700,"pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079004,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","R11.2","G89.29","K57.32","Z01.810","E11.9","I10.","I81.","Z48.815","J45.20","M51.36","M54.13","F32.9","F41.9","G47.33","K21.9","E78.00","E66.9","Z51.81","Z79.01","Z79.84","Z68.31","H10.9","H10.33","H90.3","R42.","R51.9","I63.9","R10.31","K57.30","R53.1","R29.818","R20.0","M25.551","R07.9","I82.409","N32.81","R10.2","R26.89","J45.909","M43.16","M54.16","R50.82","E08.65","E78.5","NO DATA","R07.89","R10.30","R11.0","M17.12","K50.90","Z90.49","Z86.718","M25.562","R10.32","E78.2","E87.6","G43.909","Z68.30","Z79.899","Z87.11","Z82.49","Z91.81","M79.604","R79.9","Z09.","R09.82","R73.01","R73.03","F33.1","H15.123","H20.011","H90.A21","H90.A22","H93.291","G43.109","F33.41","I35.8","G70.00","Z01.818","E66.01","Z86.73","Z68.35","M79.5","Z98.1","R26.81","R10.84","M79.662","M79.89","R79.1","G43.809","R35.0","G45.9","F41.1","Q76.2","Z01.812","T81.500A","M54.41","M17.11","M43.10","R09.89","Z87.898","J39.2","H10.32","K22.5","R29.6","R53.82","G43.101","H25.813","M25.561","K57.90","J38.5","Z20.828","K58.0","R29.810","L82.0","I83.90","L82.1","Z71.9","R07.81","R10.11","R10.819","R00.0","R79.89","Z87.19","Z99.89","S76.311A","R31.9","M12.9","Z90.710","H81.01","I51.7","R19.7","K64.0","K63.89","Z23.","E11.8","H90.5","M54.9","R30.0","R31.29","N39.3","R35.1","I82.5Y9","E11.65","R50.9","R09.02","Z98.51","Z47.89","J45.30","Z00.00","R60.9","R60.0"],"date":["2021-02-10","2021-01-08","2022-08-17","2021-03-04","2022-07-21","2022-11-19","2022-11-19","2023-04-05","2021-05-06","2022-07-28","2021-06-04","2021-06-04","2021-06-04","2022-07-28","2022-11-19","2022-07-28","2022-09-01","2022-04-07","2022-09-08","2023-03-07","2022-11-19","2022-04-07","2021-06-27","2021-07-18","2021-12-07","2022-02-11","2022-02-11","2022-02-11","2022-02-11","2022-06-17","2022-04-23","2022-02-11","2022-02-11","2022-11-22","2022-02-11","2022-02-11","2022-08-06","2022-03-16","2022-04-23","2022-11-19","2022-11-22","2023-03-28","2022-08-03","2022-08-03","2022-08-03","2023-03-28","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2023-04-05","2023-03-07","2022-08-06","2022-02-10","2022-08-06","2021-03-04","2022-09-01","2022-08-22","2021-03-04","2022-08-06","2021-04-01","2021-09-30","2022-02-17","2021-04-14","2021-04-14","2022-08-06","2022-08-06","2021-08-10","2021-08-10","2021-10-05","2021-10-05","2021-10-05","2022-07-28","2022-02-10","2022-02-10","2022-02-10","2022-07-21","2022-07-21","2022-09-01","2022-07-21","2022-09-01","2023-03-28","2021-03-11","2022-06-17","2021-09-30","2021-09-30","2021-09-30","2022-02-17","2022-02-17","2022-02-17","2022-03-14","2022-07-21","2022-07-21","2022-09-01","2022-11-19","2022-11-22","2023-03-28","2021-07-30","2021-05-06","2021-10-05","2021-06-21","2021-06-04","2021-12-20","2021-12-20","2022-02-13","2022-04-16","2022-11-19","2021-01-08","2021-07-30","2021-12-21","2022-02-26","2022-02-13","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-11-22","2021-03-31","2021-03-31","2021-03-31","2021-10-05","2022-02-11","2022-06-17","2022-06-17","2022-06-17","2022-08-17","2022-08-17","2021-07-16","2021-10-15","2022-02-24","2022-06-13","2022-06-13","2022-06-13","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-08-06","2022-08-06","2021-01-11","2023-04-19","2023-04-19"],"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":[["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE","20 MG","90","Select","Select",""],["","60505258009","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","29033000301","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","58657067601","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","50383056510","NEOMYCIN","TAB 500MG","6","Select","Select",""],["","69097097107","LISINOP\/HCTZ","TAB 20-25MG","90","Select","Select",""],["","69452034672","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","68968051408","COMBIPATCH","DIS ","8","Select","Select",""],["","70010049101","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","69784018010","POLYETH GLYC","POW 3350 NF","12","Select","Select",""],["","29300039705","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","71288041087","ENOXAPARIN","INJ 80\/0.8ML","8","Select","Select",""],["","68180035306","SERTRALINE","TAB 100MG","45","Select","Select",""],["","00056017270","COUMADIN","TAB 5MG","30","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","135","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","31722088530","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","17478010505","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","42192033801","HYOSCYAMINE","TAB 0.125MG","60","Select","Select",""],["","65628005001","FIRST-MOUTHW","SUS BLM","237","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","43547035410","LISINOPRIL","20 MG","90","Select","Select",""],["","00781207401","TRIAMT\/HCTZ","CAP 37.5-25","30","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00832712311","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","42","Select","Select",""],["","70710116201","MECLIZINE","TAB 25MG","30","Select","Select",""],["","69097012203","TOPIRAMATE","25 MG","60","Select","Select",""],["","65162068110","PHENAZOPYRID","TAB 100MG","30","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","50228018001","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB 2.5MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","14","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","11822010233","PAIN RELIEF","TAB 500MG","80","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","18","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","29300039705","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","68180035309","SERTRALINE HCL","100 MG","45","Select","Select",""],["","51672403201","WARFARIN SODIUM","5 MG","90","Select","Select",""],["","31722088530","ROSUVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","50458057930","XARELTO","20 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":""}]}]}