{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NORA  L MARLOW","gend":1,"add":"3837 SUNSTREAM PKWY","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1962-05-10","age":"","mstatus":"","insh":"2059603*01","cliId":"","pno":7574719626,"cno":7574719626,"email":"","ename":"","eno":"","pphy":"RIEDLER, SYLVIA H MD","ppno":7573952500,"pcpadd":"1024 FIRST COLONIAL RD,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - First Colonial","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572759700,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B02.9","E11.65","E78.1","Z12.2","I10.","F32.9","E28.2","E66.9","E78.2","D64.9","R06.83","R73.09","E78.5","E88.81","Z23.","F33.9","G47.19","E66.01","E11.9","Z79.4","E11.29","J42.","G47.33","R80.9","D72.9","D47.3","J44.9","F33.40","D12.6","F17.210","S50.821A","F32.2","F41.1","F31.81"],"date":["2021-12-31","2023-07-18","2021-09-21","2023-02-22","2023-07-18","2023-07-18","2023-07-18","2023-07-18","2022-11-01","2022-09-20","2022-12-13","2022-05-24","2023-07-18","2023-07-18","2022-11-01","2023-02-07","2022-11-01","2023-02-07","2022-11-01","2023-02-07","2023-02-07","2023-02-07","2023-06-02","2023-02-07","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2023-02-22","2021-12-31","2022-07-19","2022-07-19","2022-07-19"],"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":[["","68645052354","SERTRALINE","TAB 100MG","180","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","90","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","00002882427","HUMULIN R","INJ U-500","12","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","200","Select","Select",""],["","81131038679","RELION PEN","MIS 32GX4MM","200","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","30","Select","Select",""],["","68180044901","QUETIAPINE","TAB 300MG","180","Select","Select",""],["","45963014205","BUPROPN HCL","TAB 300MG XL","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","17","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","68645055754","LISINOP\/HCTZ","TAB 20-12.5","60","Select","Select",""],["","31722059690","FENOFIBRATE","145 MG","90","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","49035048482","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","49035049401","PAIN RELIEVR","TAB 500MG","30","Select","Select",""],["","57599080300","FREESTY LIBR","MIS 2 READER","1","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","49281072110","FLUBLOK QUAD","INJ 2021-22","0","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","00597015230","JARDIANCE","10 MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","72205000530","ROSUVASTATIN","TAB 40MG","30","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","30","Select","Select",""],["","00093005405","BUSPIRONE HCL","10 MG","90","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","68645055754","LISINOPRIL-HYDROCHLOROTHIAZIDE","20-12.5 MG","180","Select","Select",""],["","58160084252","BOOSTRIX TDAP","2.5-8-5\/.5","0.5","Select","Select",""],["","00002882427","HUMULIN R U-","500 KWIKPEN 500\/ML (3)","12","Select","Select",""],["","68180044901","QUETIAPINE FUMARATE","300 MG","360","Select","Select",""],["","70377000911","ROSUVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","180","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","2","Select","Select",""],["","81131038679","PEN NEEDLE","32GX 5\/32\"","200","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","16571086350","BUPROPION XL","300 MG","90","Select","Select",""],["","58160081552","TWINRIX","720-20\/ML","1","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","68645058459","METFORMIN HCL","1000 MG","180","Select","Select",""],["","68645052354","SERTRALINE TAB","100MG","180","Select","Select",""],["","00002882427","HUMULIN R INJ U-","500","12","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","17","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","200","Select","Select",""],["","81131038679","RELION PEN MIS","32GX4MM","200","Select","Select",""],["","16729044416","BUPROPN HCL TAB","300MG XL","30","Select","Select",""],["","68645058459","METFORMIN TAB","1000MG","180","Select","Select",""],["","00093005405","BUSPIRONE TAB","10MG","90","Select","Select",""],["","68645055754","LISINOP\/HCTZ TAB","20-12.5","60","Select","Select",""],["","68180044901","QUETIAPINE TAB","300MG","90","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","00093505898","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","00378306677","FENOFIBRATE TAB","145MG","90","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","90","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","17","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","31","Select","Select",""],["","72205000530","ROSUVASTATIN TAB","40MG","90","Select","Select",""],["","00169210125","NOVOLOG INJ FLEX REL","","30","Select","Select",""],["","08627007701","DEXCOM G","7 SENSOR","9","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":""}]}]}