{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATASHA  D ELEY","gend":1,"add":"664 SUMMER DAY CTS APT 305","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1979-10-11","age":"","mstatus":"","insh":"20074289*01","cliId":"","pno":7575931770,"cno":7575931770,"email":"","ename":"","eno":"","pphy":"BELVIN, DAVID G MD","ppno":7575422000,"pcpadd":"SUITE 200 20209 SENTARA WAY,","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":"23314-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Gloucester","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575109263,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M54.9","S32.421A","E27.8","Z90.49","NO DATA","D50.8","E78.2","E66.01","R10.11","J45.41","J40.","V89.0XXA","V54.13","V58.89","J16.8","J45.40","B20.","D63.1","K21.9","F41.9","F17.210","R73.9","E66.9","Z68.42","Z79.01","N93.9","Z12.31","G95.19","G89.29","R10.9","Z00.00","Z12.4","L29.9","Z13.220","L02.93","Z11.3","Z51.81","D64.9","N76.0","B96.89","S19.9XXA","V89.2XXA","Y92.414","D35.02","Z21.","D35.01","Z68.43","L68.0","E28.2","E24.9","I15.2","E34.9","S32.401A","S32.409A","D62.","E87.1","Z23.","Z20.822","S80.211A","S80.212A","M25.571","B37.0","R07.9","M25.551","J45.901","J06.9","J45.21","H92.03","V58.69","Z86.16","Z91.199"],"date":["2021-12-07","2021-11-15","2022-08-15","2023-03-22","2022-11-25","2023-02-28","2022-12-22","2022-09-07","2022-12-22","2021-10-25","2022-04-24","2022-04-24","2022-08-15","2023-02-03","2022-09-07","2022-09-07","2022-12-22","2023-05-28","2022-09-07","2022-09-07","2022-09-07","2023-05-28","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2022-12-22","2022-12-22","2023-02-28","2023-02-28","2021-07-07","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-11-15","2021-11-15","2021-11-15","2022-03-08","2022-11-03","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2023-03-22","2022-03-08","2022-03-08","2022-08-10","2023-01-27","2022-08-08","2022-08-08","2022-08-08","2023-05-28","2022-08-08","2022-08-08","2022-08-08","2021-05-29","2021-07-07","2023-02-03","2023-05-28","2023-05-28","2023-05-28","2023-05-28","2023-05-28","2023-05-28","2023-05-28"],"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":[["","49702022813","TIVICAY","50 MG","30","Select","Select",""],["","59676057530","PREZCOBIX","800-150 MG","30","Select","Select",""],["","00006306901","PIFELTRO","100 MG","30","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","240","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","150","Select","Select",""],["","69842087651","CVS ACETAMIN","TAB 325MG","90","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","90","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","73796045801","COMP AIR","MIS COMP\/NEB","1","Select","Select",""],["","00054418125","DEXAMETHASON","TAB 1MG","1","Select","Select",""],["","00093324101","BISOPRL\/HCTZ","TAB 2.5\/6.25","90","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","10","Select","Select",""],["","00378064205","PREDNISONE","20 MG","10","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","14","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","40","Select","Select",""],["","00781324664","ENOXAPARIN","INJ 40\/0.4ML","24","Select","Select",""],["","00536100901","FERROUS SULFATE","325(65) MG","30","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","90","Select","Select",""],["","64380071207","BENZONATATE","100 MG","30","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","59676057530","PREZCOBIX TAB","800-150","30","Select","Select",""],["","00093324101","BISOPRL\/HCTZ TAB","2.5\/6.25","30","Select","Select",""],["","00054418125","DEXAMETHASON TAB","1MG","1","Select","Select",""],["","49702022813","TIVICAY TAB","50MG","30","Select","Select",""],["","00006306901","PIFELTRO TAB","100MG","30","Select","Select",""],["","00378827052","ALBUTEROL NEB","0.083%","150","Select","Select",""],["","68180065208","DOXYCYC MONO CAP","100MG","10","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","8","Select","Select",""],["","00781324664","ENOXAPARIN INJ","40\/0.4ML","34","Select","Select",""],["","63304069205","CLINDAMYCIN CAP","150MG","40","Select","Select",""],["","49483060350","IBUPROFEN TAB","600MG","30","Select","Select",""],["","42858000101","OXYCODONE TAB","5MG","28","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","00536100901","FERROUS SULF TAB","325MG","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":""}]}]}