{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE A WEISS","gend":1,"add":"3301 INDIAN RIVER ROAD","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1981-02-04","age":"","mstatus":"","insh":"2114965*01","cliId":"","pno":7577395977,"cno":7577395977,"email":"","ename":"","eno":"","pphy":"MORGAN, AIMEE M PA","ppno":7574137600,"pcpadd":"STE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23464-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574137601,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.1","L28.2","E11.65","F32.9","E55.9","R80.9","K82.8","E11.9","E66.01","Z68.37","R07.89","R11.2","R19.7","R55.","J06.9","J02.9","U07.1","R42.","NO DATA","G40.909","F43.10","E10.65","R53.83","R05.","R06.09","R10.13","K52.9","E86.0","K57.30","B37.3","L29.9","Z71.9","Z20.822","R07.9","R74.01","F98.8","D72.829","M54.2","G56.03","M72.2","R06.2","E78.2","Z79.4","R09.02","Z79.899","Z88.1","Z91.040","Z88.0","Z88.8","Z91.018","F90.0","M51.9","R05.9","R06.00","Z68.39","Z86.16","R79.89","K21.9","R11.0","K22.10","K22.2","K44.9","E10.9","G43.909","J30.2","R10.9","K76.0","Z02.0","B07.0","G43.809","J12.89","R10.10","Z12.31","E11.21","E78.5","E11.29","F41.9","R63.5","L30.9","E78.00","Z90.49"],"date":["2021-01-06","2021-07-26","2022-09-26","2021-07-26","2022-02-15","2021-07-26","2021-11-05","2023-02-16","2022-03-02","2021-11-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2023-05-06","2023-05-06","2021-02-03","2023-05-01","2021-01-13","2021-01-06","2022-02-15","2021-01-06","2021-01-13","2021-02-03","2021-01-13","2021-09-09","2021-06-15","2021-06-15","2021-06-17","2021-06-17","2021-10-13","2021-10-13","2022-09-08","2022-10-05","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2023-03-02","2022-03-02","2023-02-16","2022-10-05","2021-01-01","2021-01-01","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2021-10-01","2021-03-05","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2023-02-16","2021-10-15","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-01-01","2021-06-04","2021-10-01","2021-08-13","2021-10-15","2023-04-13","2023-03-02","2023-03-10","2021-01-01","2021-08-05","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2021-02-03","2022-10-05","2022-10-05"],"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":[["","42571012290","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","50090558501","JANUVIA","TAB 100MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","30","Select","Select",""],["","59417010410","VYVANSE","40 MG","30","Select","Select",""],["","13107015790","PAROXETINE","TAB 40MG","30","Select","Select",""],["","64980028101","GLIPIZIDE ER","TAB 10MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","27808008602","HYD POL\/CPM","SUS 10-8\/5ML","100","Select","Select",""],["","68180016111","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","12","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","59762371809","TRIAZOLAM","TAB 0.25MG","2","Select","Select",""],["","00591046110","GLIPIZIDE","10 MG","90","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","30","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","08627001601","DEXCOM G6","MIS TRANSMIT","1","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","53746074501","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","00169413013","OZEMPIC","1\/0.75 (3)","3","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","53885024450","ONETOUCH ULTRA TEST STRIP","","50","Select","Select",""],["","00121077516","GUAIFENESIN-CODEINE","10-100MG\/5","120","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","64380071307","BENZONATATE","200 MG","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","15","Select","Select",""],["","42571012290","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","90","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","76204020025","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","13107015790","PAROXETINE HCL","40 MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","16571066101","MECLIZINE HCL","25 MG","30","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":""}]}]}