{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELE MAXWELL","gend":1,"add":"19 RICHLAND DR","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1961-04-21","age":"","mstatus":"","insh":"2150902*01","cliId":"","pno":7573670124,"cno":7573670124,"email":"","ename":"","eno":"","pphy":"MURDY, BRIANNA J PA","ppno":7575941850,"pcpadd":"11803 JEFFERSON AVE STE 100,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575941841,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F43.12","F41.1","F34.1","F90.0","F25.9","F11.10","L30.9","F17.200","Z79.899","R21.","R07.89","T76.21XA","F29.","S82.832A","G40.909","M79.7","Z20.822","M79.671","S41.151A","L03.113","F33.1","R56.9","NO DATA","Z04.41","F11.221","T74.21XA","J22.","Z12.31","B18.2","E78.2","Z00.8","L29.9","R69.","Z00.00","Z12.39","Z13.220","R61.","G62.9","Z94.4","Z98.890","F18.988","F22.","F15.10","Y09.","I82.409","S62.91XA","S60.512A","S60.511A","F17.210","Z23.","M79.89","S81.012A","F19.10","N30.01","E78.5","R30.0","F11.288","Z01.118","Z12.11","G89.4","M81.0","H40.033","Z02.2","Z01.810","Z01.812","R22.41","Z86.19","F15.20","L70.0","L30.8","Z71.9","R41.0","R09.02","Y04.8XXA","F99.","L03.90","S51.859A","W55.01XA","L98.9","Z68.24","S51.851A","Z87.891","Z90.710","R20.2","Z48.02"],"date":["2023-09-21","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2022-10-04","2022-10-04","2021-08-12","2022-02-06","2023-08-22","2022-08-18","2022-02-06","2022-08-10","2023-03-19","2021-05-30","2023-08-22","2023-08-22","2023-03-19","2021-10-15","2023-08-22","2023-08-22","2021-04-28","2021-10-16","2021-10-15","2022-08-10","2022-09-07","2022-08-10","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2023-03-19","2023-03-19","2022-08-10","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-05-05","2023-08-26","2021-05-05","2022-08-10","2022-01-18","2022-06-10","2022-06-10","2022-06-10","2022-09-04","2022-06-10","2022-06-10","2022-06-24","2022-08-24","2022-09-04","2022-09-04","2022-09-04","2023-05-04","2023-05-04","2021-04-06","2023-08-22","2021-05-07","2021-08-25","2022-08-18","2021-04-02","2021-04-02","2021-10-27","2021-10-27","2022-09-07","2021-04-13","2021-04-13","2021-04-13","2021-10-15","2021-10-15","2021-10-15","2022-08-10","2023-08-26","2023-08-26","2023-08-26","2023-04-05","2023-04-05","2023-08-22","2023-08-22","2023-08-22","2021-03-30","2022-07-06"],"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":[["","68462012605","GABAPENTIN","600 MG","270","Select","Select",""],["","00143211205","DOXYCYCL HYC","TAB 100MG","14","Select","Select",""],["","68382005105","MELOXICAM","15 MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","28","Select","Select",""],["","68382079201","ACYCLOVIR","800 MG","35","Select","Select",""],["","00093720298","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","49884072703","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","00832712315","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","52817031910","BACLOFEN","5 MG","30","Select","Select",""],["","43547034006","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","66685100100","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","00093720298","PRAVASTATIN SODIUM","40 MG","90","Select","Select",""],["","29300013905","DIVALPROEX SODIUM","250 MG","270","Select","Select",""],["","42799080601","IVERMECTIN","3 MG","1","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00472037915","CLOTRIMAZOLE-BETAMETHASONE","1 %-0.05 %","30","Select","Select",""],["","04142000024","FLORASTOR","250 MG","20","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15\/5","118","Select","Select",""],["","00781808926","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","12","Select","Select",""],["","45802026937","PERMETHRIN","5 %","60","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":""}]}]}