{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY BAILEY","gend":0,"add":"741 MONTICELLO AVE 201 E LITTLE CREEK RD","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1964-09-20","age":"","mstatus":"","insh":"20069915*01","cliId":"","pno":7579556516,"cno":7579556516,"email":"","ename":"","eno":"","pphy":"TISDALE, JENNIFER N PAC","ppno":7573889925,"pcpadd":"7401 GRANBY ST,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579658519,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.14","F41.9","L03.114","Z23.","F20.9","W50.3XXA","B18.2","NO DATA","F17.200","Z01.812","Z20.822","Z47.2","S62.617S","F11.20","D53.9","Z68.20","D70.9","F33.3","S00.81XA","R29.6","F17.210","S09.90XA","F11.23","F11.24","F14.20","F14.24","R03.0","T14.8XXA","R21.","Z79.891","N48.89","M54.9","R53.83","F14.10","F25.1","D64.9","G89.29","S62.617B","L97.511","R81.","Z13.1","Z13.0","Z13.220","Z12.5","Z87.891","H40.013","S62.617A","R52.","R79.0","W50.3XXD","Z01.818","S62.619A","M54.2","F31.10","M54.41","M79.606","Z86.19","R20.2","M25.50","M19.90","F10.239","M54.42","M25.562","F16.21","Z59.00","R74.01","M79.605","F40.10","F25.0"],"date":["2021-07-22","2022-11-28","2021-03-04","2022-11-28","2023-09-19","2021-03-11","2021-03-01","2023-08-01","2022-08-26","2021-04-17","2021-04-17","2021-04-19","2021-04-19","2023-09-19","2022-11-28","2022-11-28","2022-11-28","2023-01-22","2023-02-04","2023-02-12","2023-05-16","2023-02-04","2023-05-21","2021-05-20","2021-05-17","2021-05-17","2021-05-18","2022-08-02","2022-08-02","2022-08-02","2023-01-10","2023-05-17","2023-05-17","2021-05-20","2023-08-27","2023-02-12","2023-04-29","2021-03-11","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-09-07","2021-04-19","2023-01-25","2023-01-25","2021-03-04","2021-03-05","2021-03-05","2023-01-25","2023-07-02","2023-03-31","2023-03-31","2023-03-31","2023-03-31","2023-04-20","2023-05-16","2023-05-21","2023-04-29","2023-04-20","2023-05-16","2023-05-16","2023-05-16","2023-05-17","2023-09-19","2023-05-23"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","2","Select","Select",""],["","00185061501","HYDROXYZ PAM","CAP 50MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","10","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","65162046550","IBUPROFEN","600 MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","28","Select","Select",""],["","68382080501","TRAZODONE","TAB 50MG","30","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","2","Select","Select",""],["","00172392660","DIAZEPAM","5 MG","8","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","59746017306","PREDNISONE","10 MG","26","Select","Select",""],["","70010077001","METHOCARBAMOL","750 MG","20","Select","Select",""],["","63304061650","DOXYCYCLINE MONOHYDRATE","100 MG","14","Select","Select",""],["","65162079108","LIDOCAINE","5 %","30","Select","Select",""],["","11822010233","ACETAMINOPHEN","500 MG","30","Select","Select",""],["","70954001910","PRAZOSIN HCL","1 MG","14","Select","Select",""],["","00904728060","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","00093506101","HYDROXYZINE HCL","25 MG","60","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","10","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","10","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","12","Select","Select",""],["","65862018601","CLINDAMYCIN CAP","300MG","28","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","60","Select","Select",""],["","00093506101","HYDROXYZ HCL TAB","25MG","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":""}]}]}