{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY L ROUNTREE","gend":1,"add":"5510 KEYDET DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1981-10-08","age":"","mstatus":"","insh":"2110509*01","cliId":"","pno":7574507914,"cno":7574507914,"email":"","ename":"","eno":"","pphy":"PATEL, NITI K MD","ppno":7573951700,"pcpadd":"3745 HOLLAND RD STE 200,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079004,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","E66.01","J96.01","M54.40","R73.09","A41.89","R73.9","NO DATA","J96.11","E11.65","M19.011","M17.12","G43.701","Z86.16","Z87.01","Z68.41","Z91.81","J06.9","N89.8","Z11.3","H20.9","H40.043","H35.61","H35.051","H35.82","H43.811","H34.8311","H35.371","Z01.419","Z12.39","R06.83","I10.","G47.33","R35.1","M25.512","M25.511","S46.812A","S46.811A","Z20.822","R55.","J84.9","Z00.00","Z68.42","E74.39","M19.90","E78.00","H04.123","I11.9","R06.09","E11.9","R06.81","R40.0","M25.561","R73.01","G89.29","M25.562","L50.0","M25.571","M21.41","M21.42","L65.9","Z88.0","Z88.8","R50.9","Z30.09","Z30.2","Z20.828","T38.0X5A","G43.709","M54.9","Z79.899","Z97.5","Z82.49","Z83.2","Z82.61","Z09.","B37.3","Z12.31","V58.89","R03.0","N92.6","Z30.431","E83.42","E78.5","L65.0","M62.838","E66.9","R09.81"],"date":["2022-06-28","2023-04-06","2022-06-28","2021-09-18","2021-09-23","2022-06-28","2021-09-27","2022-06-28","2021-10-22","2023-03-02","2021-10-22","2021-10-22","2021-10-22","2023-09-11","2021-10-22","2021-10-22","2021-10-22","2023-09-11","2022-06-08","2022-06-08","2023-08-14","2023-08-14","2022-10-17","2022-10-17","2023-07-24","2023-07-24","2023-07-24","2023-07-24","2022-12-06","2021-08-12","2023-04-24","2022-10-21","2022-10-21","2022-10-21","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2023-09-11","2021-09-16","2021-09-16","2022-02-04","2023-04-06","2022-02-04","2022-02-04","2022-02-04","2022-08-26","2023-04-24","2023-04-24","2023-03-06","2022-07-20","2022-07-20","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2023-02-07","2021-06-04","2021-06-04","2021-06-04","2021-11-03","2022-01-06","2022-01-06","2022-01-06","2022-05-06","2022-05-06","2021-09-09","2021-09-19","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-10-05","2021-10-05","2023-03-02","2021-11-22","2021-11-22","2022-01-13","2022-01-13","2022-10-07","2023-04-24","2021-12-22","2023-04-06","2023-09-11","2023-09-11"],"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":[["","68462019005","NAPROXEN","TAB 500MG","180","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70010006310","METFORMIN","TAB 500MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00536132701","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","11523716201","CLARITIN-D","TAB 5-120MG","20","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00363237102","LANCETS MICR","MIS THIN 33G","100","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","1","Select","Select",""],["","00781600078","DIFLUPREDNAT","EMU 0.0005","5","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","00088502005","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","6","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","56151147002","TRUE METRIX","KIT METER","1","Select","Select",""],["","42806071501","BENZONATATE","200 MG","20","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","59651036105","IBUPROFEN","600 MG","20","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00168034646","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","68462056830","AMLOD\/OLMESA","TAB 5-40MG","90","Select","Select",""],["","24208050307","LOTEMAX","GEL 0.005","5","Select","Select",""],["","17478083005","LOTEPREDNOL","GEL 0.005","5","Select","Select",""],["","70727049725","RHOPRESSA","SOL 0.0002","2","Select","Select",""],["","60569049460","MAGOX 400","TAB 400MG","45","Select","Select",""],["","00781718675","BRIMO\/TIMOLO","SOL 0.2\/0.5%","5","Select","Select",""],["","72205002305","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","68462056830","AMLODIPINE-OLMESARTAN","5 MG-40 MG","90","Select","Select",""],["","00781718675","BRIMONIDINE TARTRATE-TIMOLOL","0.2%-0.5%","5","Select","Select",""],["","61314063705","PREDNISOLONE ACETATE","1 %","5","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","10","Select","Select",""],["","29300041301","CYCLOBENZAPRINE HCL","5 MG","20","Select","Select",""],["","59651026905","GLIPIZIDE ER","5 MG","30","Select","Select",""],["","16571020150","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","55111032101","GLIMEPIRIDE","2 MG","30","Select","Select",""],["","69584085250","SPIRONOLACTONE","25 MG","90","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","6","Select","Select",""],["","68682029905","LOTEPREDNOL ETABONATE","0.5 %","5","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","20","Select","Select",""],["","42806071501","BENZONATATE CAP","200MG","20","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","50","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00781600078","DIFLUPREDNAT EMU","0.05%","5","Select","Select",""],["","00168034646","TERCONAZOLE CRE","0.4%","45","Select","Select",""],["","53746051105","SPIRONOLACT TAB","25MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","68462056830","AMLOD\/OLMESA TAB","5-40MG","90","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","60","Select","Select",""],["","55111012205","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","68682029905","LOTEPREDNOL SUS","0.5%","5","Select","Select",""],["","24208029905","LOTEMAX SUS","0.5%","5","Select","Select",""],["","00781718675","BRIMO\/TIMOLO SOL","0.2\/0.5%","5","Select","Select",""],["","70727049725","RHOPRESSA SOL","0.02%","2","Select","Select",""],["","65862018601","CLINDAMYCIN CAP","300MG","21","Select","Select",""],["","17478083005","LOTEPREDNOL GEL","0.5%","5","Select","Select",""],["","61314063705","PREDNISOLONE SUS","1% OP","5","Select","Select",""],["","24208050307","LOTEMAX GEL","0.5%","5","Select","Select",""],["","60569049460","MAGOX","400 TAB 400MG","15","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","63824004124","MUCINEX D","1200-120MG","20","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":""}]}]}