{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES FORD","gend":0,"add":"2014 OREGON AVE APT C","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1981-04-10","age":"","mstatus":"","insh":"20082446*01","cliId":"","pno":7579744702,"cno":7579744702,"email":"","ename":"","eno":"","pphy":"FRANK, JANINE M MD","ppno":"","pcpadd":"4124 CHESAPEAKE SQUARE BLVD STE 103","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Chesapeake Square","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576738291,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.90","T81.42XA","A49.8","L08.9","R07.89","E87.6","Z79.01","T82.7XXA","J96.01","J96.02","N17.9","D68.9","D62.","NO DATA","E86.1","J81.1","B96.5","E87.70","F17.210","Z79.82","Z86.16","Z86.711","J95.821","I48.91","G89.18","J95.89","J81.0","Q20.4","T82.110A","R10.9","R05.1","I50.9","Z87.74","Z87.442","Z88.2","Z88.8","V58.89","R60.0","I97.110","E87.2","I21.3","R78.81","Q22.4","D69.6","R65.10","R18.8","I95.9","I50.22","K74.60","D64.9","Q21.0","Z20.822","Z79.899","Z95.5","R50.9","T82.7XXS","T81.89XA","Z48.01","F41.9","Z95.0","U07.1","Z95.828","D72.819","Q24.9","I10.","S30.1XXA","S21.101A","R07.9","R06.02","R10.84","Z01.818","Q20.8","Z01.810","I51.7","Q20.3","R20.0","Z98.890","A41.9","T81.9XXA","Z09.","A41.89","J96.21","K76.6","I42.9","F17.290","K80.20","I48.0","F43.21","K70.31","K21.9","R09.02","L02.213","Z79.2","Z87.01","F12.10","Z51.89","Q25.49","T81.41XA","R73.9","J96.20","R05.9","G47.33","G89.29"],"date":["2022-10-22","2022-10-22","2022-10-22","2023-04-25","2023-04-25","2023-02-01","2022-10-28","2023-04-25","2022-10-04","2022-10-04","2022-10-04","2022-09-30","2022-10-01","2022-12-07","2022-09-30","2022-09-30","2022-11-17","2022-11-21","2022-11-17","2022-11-17","2022-09-30","2022-09-30","2022-10-06","2022-12-19","2022-11-21","2022-10-05","2022-10-06","2022-12-21","2022-10-12","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2022-11-17","2022-10-26","2022-12-19","2022-12-07","2022-12-07","2022-09-30","2022-10-04","2022-10-27","2022-10-28","2022-10-31","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-11-17","2022-11-18","2022-11-17","2022-11-17","2022-10-27","2022-10-31","2022-10-31","2022-12-01","2022-12-19","2022-12-19","2022-12-19","2022-08-20","2022-08-30","2022-08-20","2022-10-28","2022-09-07","2022-10-11","2022-11-22","2022-11-17","2022-08-30","2022-08-30","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-11-18","2022-10-01","2022-10-01","2022-10-29","2022-11-17","2022-04-29","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-22","2023-04-25","2022-08-30","2022-08-30","2022-08-30","2022-10-21","2022-10-28","2022-11-17","2022-11-17","2022-11-18","2022-10-26","2022-10-31","2023-04-25"],"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":[["","13668058130","TADALAFIL","20 MG","60","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","20","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","50228018010","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","20","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","30","Select","Select",""],["","16729016901","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","57237001106","MIRTAZAPINE","15 MG","15","Select","Select",""],["","00832712211","DIVALPROEX","TAB 125MG DR","90","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","9","Select","Select",""],["","68462016505","CARVEDILOL","25 MG","60","Select","Select",""],["","00143992950","CIPROFLOXACN","TAB 750MG","10","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","90","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","28","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","70436015301","POT CHLORIDE","TAB 20MEQ ER","7","Select","Select",""],["","63304072190","DILTIAZEM","24HR ER (CD) 300 MG","30","Select","Select",""],["","57896048914","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","00713028031","BACITRACIN","OIN 500\/GM","114","Select","Select",""],["","00056017270","COUMADIN","TAB 5MG","36","Select","Select",""],["","65162062711","TRAMADOL HCL","50 MG","54","Select","Select",""],["","00378617201","METOLAZONE","2.5 MG","30","Select","Select",""],["","68382052701","BUMETANIDE","2 MG","60","Select","Select",""],["","00832121600","JANTOVEN","TAB 5MG","36","Select","Select",""],["","70010077005","METHOCARBAM","TAB 750MG","120","Select","Select",""],["","57664044188","DIGOXIN","250 MCG","30","Select","Select",""],["","67618010110","COLACE","CAP 100MG","40","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","30","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","40","Select","Select",""],["","62037099901","POTASSIUM CHLORIDE","20 MEQ","90","Select","Select",""],["","53746051105","SPIRONOLACTONE","25 MG","60","Select","Select",""],["","65862015901","ZOLPIDEM TARTRATE","5 MG","14","Select","Select",""],["","43598044674","NICOTINE PATCH","7MG\/24HR","28","Select","Select",""],["","00245531990","KLOR-CON M","20 20 MEQ","30","Select","Select",""],["","00245010811","FERROUS SULFATE","325(65) MG","90","Select","Select",""],["","68585000801","ZINC SULFATE","50(220)MG","30","Select","Select",""],["","65862007850","CIPROFLOXACIN HCL","750 MG","48","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","100 MG","28","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":""}]}]}