{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTOINETTE  F SHNOODA","gend":1,"add":"1559 FAIRFAX DR","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1972-11-18","age":"","mstatus":"","insh":"20080735*01","cliId":"","pno":7574345881,"cno":7574345881,"email":"","ename":"","eno":"","pphy":"WILLIAMS, KEISHA J MD","ppno":7574137600,"pcpadd":"5320 PROVIDENCE RD STE 301","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23464-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574137601,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C22.0","K74.60","I82.0","Z68.21","M65.341","R42.","R18.8","J10.1","Z91.012","Z88.8","Z20.822","R06.02","R05.8","N76.0","R10.30","D45.","L60.8","B07.9","D75.9","M35.9","K80.70","M32.9","J45.909","Z86.718","R11.2","K74.69","K76.6","I85.10","R10.11","D50.9","K80.20","K80.50","K81.0","J20.9","D75.1","B34.9","Z12.11","M19.90","G43.909","Z79.82","Z79.899","Z88.6","D47.3","J06.9","R14.0","N94.89","K75.81","J45.40","M15.9","Z00.00","L60.9","I85.00"],"date":["2022-08-15","2023-01-23","2023-03-14","2022-08-29","2022-10-11","2022-10-11","2022-10-26","2022-10-26","2023-01-23","2022-10-26","2022-10-26","2022-10-26","2022-01-18","2022-04-15","2022-04-15","2023-03-08","2023-03-15","2023-03-15","2023-01-11","2022-12-15","2022-06-21","2023-01-23","2023-01-23","2023-01-23","2022-06-21","2022-11-10","2023-01-23","2022-11-10","2022-11-10","2023-01-23","2023-01-23","2022-06-27","2022-06-27","2022-10-19","2022-10-19","2022-10-26","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2022-02-17","2023-01-04","2022-01-17","2022-04-26","2022-12-15","2022-12-15","2022-12-09","2022-12-15","2022-12-15","2023-01-23"],"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":[["","43547040111","FUROSEMIDE","20 MG","60","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","180","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","12","Select","Select",""],["","16729022601","SPIRONOLACT","TAB 50MG","60","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","78206011403","ASMANEX 14","AER 220MCG","1","Select","Select",""],["","76385013301","NADOLOL","20 MG","30","Select","Select",""],["","00591299801","URSODIOL","250 MG","180","Select","Select",""],["","78206011402","ASMANEX 60","AER 220MCG","1","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","78206011401","ASMANEX 120","AER 220MCG","1","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","10","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","12","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","25","Select","Select",""],["","53746051401","SPIRONOLACTONE","50 MG","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":""}]}]}