{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA  L ENROUGHTY","gend":1,"add":"2509 CASTLE HILL CTS","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1964-10-06","age":"","mstatus":"","insh":"20074291*01","cliId":"","pno":7204162622,"cno":7204162622,"email":"","ename":"","eno":"","pphy":"URENA HERNANDEZ, JOHAN S MD","ppno":7572529800,"pcpadd":"1380 TUSCANY DR,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Nimmo","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572759793,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M35.00","R60.0","Z87.898","F90.9","G47.00","F41.9","F33.1","F32.9","F51.01","K59.02","D72.810","G62.9","M35.09","NO DATA","N81.5","N81.6","T88.7XXA","H16.223","R10.11","C76.0","Z91.041","Z53.29","Z88.0","Z88.8","R06.02","D80.1","Z92.21","Z92.3","Z86.19","G62.89","F43.23","F39.","R53.83","L65.9","K59.00","N95.2","R11.2","R14.0","Z85.89","L59.8","C10.3","D72.818","G89.4","U07.1","E53.8","H10.9","H04.123","G62.0","M54.16","M51.37","M47.817","M47.816","G90.1","C06.2","K59.9","G56.01","K11.8","R19.8","R07.9","D72.819","E03.9","M79.18","K31.84","J45.909","T45.1X5A","L68.0","R63.4","R10.9","R19.4","M54.6","G62.82","M79.2","Z87.39","L57.0","L72.9","I78.1","D22.9","L82.1","L81.4","Z85.828","Z12.83","Z71.9","F41.0","F51.04","R10.84","K63.89","R07.0","R07.89","E28.2","Z79.899","Z98.82","Z82.49","C77.9","D70.8","R64.","M35.02","G44.019","R11.0","N95.1","E27.40","E23.0","Z78.0","R00.0","H01.002","N95.9","Z87.19","M79.7","B37.0","M81.0","L64.9","R94.7"],"date":["2022-04-01","2021-04-19","2021-04-19","2021-10-19","2022-01-20","2021-10-19","2021-12-10","2022-02-09","2022-02-09","2021-09-24","2022-12-15","2021-12-21","2021-11-04","2021-11-04","2021-10-04","2022-02-22","2021-10-04","2021-11-22","2021-12-07","2021-12-03","2021-12-04","2021-12-03","2021-12-04","2021-12-04","2021-12-03","2022-01-27","2021-12-09","2021-12-09","2021-12-09","2021-12-21","2022-04-05","2022-04-05","2022-01-20","2022-01-25","2022-04-01","2021-06-29","2021-09-23","2021-09-23","2021-10-14","2021-10-14","2022-03-07","2022-03-07","2022-01-04","2022-02-09","2022-03-07","2021-04-06","2021-04-06","2022-01-05","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-10-25","2021-05-26","2021-05-26","2021-05-26","2021-11-04","2022-01-13","2021-11-04","2021-11-04","2023-04-13","2021-07-08","2021-07-19","2021-07-19","2022-01-05","2023-04-13","2022-05-26","2021-12-04","2021-09-02","2021-10-25","2021-11-01","2021-11-01","2021-11-01","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2022-01-25","2022-04-05","2022-04-05","2022-01-27","2022-03-04","2021-07-01","2021-11-16","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-12-04","2022-04-26","2021-11-09","2021-09-03","2021-09-03","2021-11-16","2021-11-16","2021-11-16","2021-12-04","2021-12-04","2022-12-15","2023-04-13","2023-04-13","2023-04-13"],"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":[["","54092054701","MOTEGRITY","2 MG","30","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","70069013101","TOBRAMYCIN","SOL 0.3% OP","5","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","16729010912","QUETIAPINE","TAB 150MG ER","30","Select","Select",""],["","49035043015","EYE ALLERGY","SOL RELIEF","15","Select","Select",""],["","00527495432","LEVOTHYROXIN","CAP 75MCG","90","Select","Select",""],["","71858002004","TIROSINT","75 MCG","30","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","00093342601","LORAZEPAM","1 MG","30","Select","Select",""],["","51672412401","CARBAMAZEPIN","TAB 200MG ER","30","Select","Select",""],["","00456120330","LINZESS","72 MCG","30","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00093406701","PRAZOSIN HCL","CAP 1MG","30","Select","Select",""],["","62756058988","LIOTHYRONINE","TAB 5MCG","30","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","63323069404","ACETYLCYST","SOL 0.2","16","Select","Select",""],["","16729017317","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","16571068701","HYDROXYCHLOR","TAB 200MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","16714008310","HYDROXYZ HCL","TAB 50MG","120","Select","Select",""],["","00093354143","ESTRADIOL","CRE 0.0001","42","Select","Select",""],["","68462022401","LITHIUM CARB","TAB 450MG ER","30","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","14","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","43598065530","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","72205001290","PREGABALIN","CAP 50MG","270","Select","Select",""],["","00023916330","RESTASIS","EMU 0.05% OP","60","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","49035030603","EQ CLEARLAX","POW ","510","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","10","Select","Select",""],["","00005197105","PREVNAR 13","INJ ","0","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","5","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","65862086099","FAMOTIDINE","TAB 40MG","60","Select","Select",""],["","62332014131","CELECOXIB","CAP 100MG","20","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","55111014330","FLUCONAZOLE","50 MG","30","Select","Select",""],["","00527512162","NYSTATIN","SUS 100000","60","Select","Select",""],["","12547078020","ROGAINE","SOL 2% WOMEN","120","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","12","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","42","Select","Select",""],["","46287050001","SORBITOL","SOL 0.7","900","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","28","Select","Select",""],["","42192032901","NP THYROID","TAB 30MG","45","Select","Select",""],["","50261011018","IMVEXXY STRT","SUP 10MCG","18","Select","Select",""],["","50261011008","IMVEXXY MAIN","SUP 10MCG","8","Select","Select",""],["","60505620202","CYCLOSPORINE","EMU 0.05% OP","60","Select","Select",""],["","72305007530","EUTHYROX","TAB 75MCG","90","Select","Select",""],["","00023530105","RESTASIS MUL","EMU 0.05% OP","6","Select","Select",""],["","00032122407","CREON","CAP 24000UNT","180","Select","Select",""],["","43478024245","TRETINOIN","0.05 %","45","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","16571068701","HYDROXYCHLOROQUINE SULFATE","200 MG","30","Select","Select",""],["","13533080040","GAMUNEX-C","40 G\/400ML","400","Select","Select",""],["","70010010810","GABAPENTIN CAP","100MG","60","Select","Select",""],["","00093342601","LORAZEPAM TAB","1MG","15","Select","Select",""],["","16729044917","LEVOTHYROXIN TAB","75MCG","90","Select","Select",""],["","00023916330","RESTASIS EMU","0.05% OP","60","Select","Select",""],["","71858002004","TIROSINT CAP","75MCG","90","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","14","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00574402435","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","12547078020","ROGAINE SOL","2% WOMEN","120","Select","Select",""],["","00093354143","ESTRADIOL CRE","0.01%","42","Select","Select",""],["","16571068701","HYDROXYCHLOR TAB","200MG","90","Select","Select",""],["","62756058988","LIOTHYRONINE TAB","5MCG","30","Select","Select",""],["","50228017705","GABAPENTIN TAB","600MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","60","Select","Select",""],["","45802086803","POLYETH GLYC POW","3350 NF","510","Select","Select",""],["","50111078710","AZITHROMYCIN TAB","250MG","12","Select","Select",""],["","54092054701","MOTEGRITY TAB","2MG","30","Select","Select",""],["","68180044601","QUETIAPINE TAB","50MG","90","Select","Select",""],["","00093005405","BUSPIRONE TAB","10MG","90","Select","Select",""],["","68645052354","SERTRALINE TAB","100MG","30","Select","Select",""],["","46287050001","SORBITOL SOL","70%","900","Select","Select",""],["","00456120330","LINZESS CAP","72MCG","30","Select","Select",""],["","65649030302","XIFAXAN TAB","550MG","42","Select","Select",""],["","72205001290","PREGABALIN CAP","50MG","90","Select","Select",""],["","65862044930","VALACYCLOVIR TAB","1GM","30","Select","Select",""],["","65162027250","SMZ\/TMP DS TAB","800-160","28","Select","Select",""],["","00527495432","LEVOTHYROXIN CAP","75MCG","90","Select","Select",""],["","50261011018","IMVEXXY STRT SUP","10MCG","18","Select","Select",""],["","50261011008","IMVEXXY MAIN SUP","10MCG","8","Select","Select",""],["","42192032901","NP THYROID TAB","30MG","270","Select","Select",""],["","60505620202","CYCLOSPORINE EMU","0.05% OP","60","Select","Select",""],["","00023530105","RESTASIS MUL EMU","0.05% OP","6","Select","Select",""],["","72305007530","EUTHYROX TAB","75MCG","90","Select","Select",""],["","00032122407","CREON CAP","24000UNT","180","Select","Select",""],["","55111014330","FLUCONAZOLE TAB","50MG","30","Select","Select",""],["","51672407008","CETIRIZINE HCL","1 MG\/ML","150","Select","Select",""],["","00527495432","LEVOTHYROXINE SODIUM","75 MCG","30","Select","Select",""],["","70700026894","FOSFOMYCIN TROMETHAMINE","3 G","1","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":""}]}]}