{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIMOTHY PEBLEY","gend":0,"add":"12015 JEFFERSON AVE RM 203","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1963-06-16","age":"","mstatus":"","insh":"20078043*01","cliId":"","pno":7578288268,"cno":7578288268,"email":"","ename":"","eno":"","pphy":"RANDALL, SOMER A NP","ppno":7573454600,"pcpadd":"STE 450 400 SENTARA CIR","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573454601,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","T14.90XA","R22.42","M25.562","M16.12","R21.","J30.89","N52.9","E11.65","E11.42","R22.41","I48.0","I10.","M17.12","I50.32","F41.8","E78.2","J43.9","G47.33","F51.01","D17.24","J84.10","Z99.81","Z87.891"],"date":["2022-04-26","2022-04-26","2022-01-13","2022-01-13","2023-05-15","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2022-03-18","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-03-29","2022-03-18","2022-03-18","2022-03-18"],"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":[["","70700015010","OMEPRAZOLE","20 MG","60","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","90","Select","Select",""],["","63402091164","BROVANA","NEB 15MCG","120","Select","Select",""],["","70748025730","ARFORMOTEROL","NEB 15\/2ML","120","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","14","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","270","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","180","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","62332014131","CELECOXIB","CAP 100MG","60","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","225","Select","Select",""],["","00597008717","ATROVENT HFA","AER 17MCG","13","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","47335063149","BUDESONIDE","0.25MG\/2ML","120","Select","Select",""],["","51672127501","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","31722071101","SILDENAFIL","TAB 100MG","10","Select","Select",""],["","70010016305",""," ","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00378363705","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","49035045875","ALLERGY REL","TAB 10MG","90","Select","Select",""],["","55289056330","ACETAMIN","TAB 325MG","90","Select","Select",""],["","53885024450","ONETOUCH ULTRA TEST STRIP","","50","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","31722053401","METHOCARBAMOL","750 MG","180","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","180","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","50228018010","GABAPENTIN","300 MG","180","Select","Select",""],["","00093595556","ARFORMOTEROL TARTRATE","15MCG\/2ML","120","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","70010016305","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","49035045875","ALLERGY RELIEF","10 MG","90","Select","Select",""],["","49502080693","YUPELRI","175MCG\/3ML","90","Select","Select",""],["","68382056410","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","31722070290","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","00169430330","RYBELSUS","3 MG","30","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","43547028950","BUPROPION HCL SR","150 MG","180","Select","Select",""],["","31722071101","SILDENAFIL CITRATE","100 MG","10","Select","Select",""],["","00093100301","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","68382080601","TRAZODONE HCL","100 MG","90","Select","Select",""],["","68645058459","METFORMIN HCL","1000 MG","180","Select","Select",""],["","64980028005","GLIPIZIDE ER","5 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":""}]}]}