{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN H BURNS","gend":0,"add":"1001 BOLLING AVE UNIT 210","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1958-10-27","age":"","mstatus":"","insh":"20081775*01","cliId":"","pno":7572088887,"cno":7572088887,"email":"","ename":"","eno":"","pphy":"PERKINS, LORRAINE K NP","ppno":7572202795,"pcpadd":"STE 200 4374 NEW TOWN AVE,","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - New Town","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572598797,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N40.1","R97.20","N13.8","R33.9","Z78.9","I10.","NO DATA","E78.5","N18.4","I12.9","R80.9","E79.8","L57.0","L82.1","L81.4","D18.01","L57.8","D22.9","Z12.83","Z71.9","Z23.","M19.072","M20.12","M76.892","M21.612","Z87.39","E55.9","F30.10","F32.89","Z00.00","F31.78","F41.9","F10.10","R59.9","N31.8","I25.10","R94.39","Z12.5","M20.21","M21.611","Q66.211","M20.22","Z09.","I78.1","Q66.12","Z01.818","Z01.810","F31.9","Z79.899","N40.0","N31.2","Q66.221","I49.3","R00.1","Q66.229","M1A.9XX1","Q66.222","M76.899","M10.9","Z86.59","R94.4","E79.0","N13.9"],"date":["2023-08-29","2023-08-29","2023-08-29","2023-02-20","2023-03-24","2023-05-24","2023-03-24","2023-03-24","2023-07-14","2023-07-14","2023-07-14","2023-07-14","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2022-05-18","2022-08-05","2022-08-05","2022-12-02","2022-12-01","2022-07-19","2022-05-18","2022-03-23","2023-05-24","2022-05-18","2022-11-23","2022-05-18","2022-07-19","2022-10-05","2022-10-05","2022-12-29","2022-12-29","2023-05-24","2022-08-05","2022-08-05","2022-08-05","2022-12-01","2023-08-29","2022-05-06","2022-08-05","2022-12-05","2022-12-09","2022-12-06","2022-12-06","2023-01-04","2022-09-12","2022-07-19","2022-12-08","2022-12-08","2022-08-05","2022-08-05","2022-12-01","2022-12-01","2023-01-04","2022-07-19","2022-07-19","2022-10-05","2022-12-09"],"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":[["","43547037009","VALSARTAN","320 MG","90","Select","Select",""],["","68180032002","BUPROPN HCL","TAB 300MG XL","90","Select","Select",""],["","68462016405","CARVEDILOL","12.5 MG","180","Select","Select",""],["","16729009015","FINASTERIDE","TAB 5MG","90","Select","Select",""],["","31722052110","HYDRALAZINE","TAB 50MG","270","Select","Select",""],["","65862022701","LAMOTRIGINE","25 MG","90","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","41","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","60219170705","PREDNISONE","TAB 10MG","30","Select","Select",""],["","31722051901","HYDRALAZINE HCL","10 MG","270","Select","Select",""],["","68180032002","BUPROPION XL","300 MG","90","Select","Select",""],["","13811071910","NITROFURANTOIN MONO-MACRO","100 MG","10","Select","Select",""],["","65162062750","TRAMADOL HCL","50 MG","12","Select","Select",""],["","75826011510","PHENAZOPYRIDINE HCL","200 MG","15","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","00069236210","COMIRNATY","2023-2024 30 MCG\/0.3","0.3","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":""}]}]}