{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE L DEANE","gend":1,"add":"8297 RICHMOND ROAD","city":"TOANO","state":"VA","zip":"23168-9998","dob":"1972-04-06","age":"","mstatus":"","insh":"2143717*01","cliId":"","pno":7577843780,"cno":7577843780,"email":"","ename":"","eno":"","pphy":"JAVERNICK, MICHAEL J MD","ppno":7573454600,"pcpadd":"STE 450 400 SENTARA CIRCLE,","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573454601,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J34.0","R63.6","Z72.0","R42.","R53.83","C53.9","C53.0","K59.09","R14.2","E83.42","D50.0","G43.809","H93.13","R31.29","S39.012A","J30.9","N95.0","R79.89","R82.81","I73.00","B00.1","T16.2XXA","R19.5","K59.00","Z80.0","J01.40","L73.9","M25.512","Z23.","J30.89","F17.200","H81.11","H93.293","G43.909","N89.8","N93.9","F41.1","E86.0","N17.9","R21.","F17.210","NO DATA","Z79.899","Z45.2","E87.6","R15.2","R19.4","R11.0","Z85.41","K12.2","R10.10","K59.04","L03.211","R39.89","N88.9","Z51.0","H93.233","Z98.890","F33.1","H90.3","R63.4","Z71.3","Z68.1","F43.9","Z51.11"],"date":["2021-04-12","2021-03-12","2023-08-21","2022-03-16","2022-01-05","2023-08-15","2023-08-15","2022-08-09","2022-11-22","2022-08-09","2022-09-26","2022-03-16","2022-08-16","2022-04-25","2022-06-09","2022-06-09","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-06-19","2022-08-02","2023-08-21","2022-10-25","2022-11-07","2021-04-12","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2022-01-04","2022-02-24","2022-02-24","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-07-08","2022-08-16","2023-03-02","2023-03-02","2023-08-21","2023-08-21","2022-11-25","2023-05-04","2023-05-04","2021-02-17","2022-04-12","2022-04-21","2022-07-22","2022-11-22","2022-06-02","2023-08-15","2023-08-14","2023-08-21","2023-08-21","2023-08-21","2023-08-21","2022-09-01"],"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":[["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","00187526701","MAGONATE","LIQ 1000\/5ML","150","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571082201","LORATADINE","10 MG","30","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","40","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","60","Select","Select",""],["","15127035401","SB HEMORRHOI","OIN ","28","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","50","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","00527145006","DRONABINOL","CAP 2.5MG","60","Select","Select",""],["","10702000601","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","42","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","00603154358","POT CHLORIDE","SOL 0.2","225","Select","Select",""],["","43598016430","OLANZAPINE","TAB 5MG","21","Select","Select",""],["","66993000210","ESTRADIOL","0.01 %","42.5","Select","Select",""],["","65162022621","YUVAFEM","10 MCG","8","Select","Select",""],["","00430375414","ESTRACE","0.01 %","42.5","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","13668000901","CITALOPRAM HBR","10 MG","30","Select","Select",""],["","00228202950","ALPRAZOLAM TAB","0.5MG","30","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","15127035401","SB HEMORRHOI OIN","","28","Select","Select",""],["","10006073038","MAG OXIDE TAB","400MG","60","Select","Select",""],["","10702000601","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","00527145006","DRONABINOL CAP","2.5MG","60","Select","Select",""],["","50383066730","LIDO\/PRILOCN CRE","2.5-2.5%","30","Select","Select",""],["","00904685260","LORATADINE TAB","10MG","30","Select","Select",""],["","59746012106","MECLIZINE TAB","25MG","30","Select","Select",""],["","00054418425","DEXAMETHASON TAB","4MG","42","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","30","Select","Select",""],["","43598016430","OLANZAPINE TAB","5MG","21","Select","Select",""],["","00187526701","MAGONATE LIQ","1000\/5ML","600","Select","Select",""],["","00603154358","POT CHLORIDE SOL","20%","225","Select","Select",""],["","00172572880","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","62037099901","POT CL MICRO TAB","20MEQ ER","30","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","40","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","50","Select","Select",""],["","00093031101","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","59746011506","PROCHLORPERAZINE MALEATE","10 MG","30","Select","Select",""],["","60258017101","MAGNESIUM OXIDE","400 MG","60","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","68382080601","TRAZODONE HCL","100 MG","30","Select","Select",""],["","65862044930","VALACYCLOVIR","1000 MG","20","Select","Select",""],["","00168004046","BETAMETHASONE VALERATE","0.1 %","45","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":""}]}]}