{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA FOK","gend":1,"add":"528 KING GEORGE ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1976-08-01","age":"","mstatus":"","insh":"2173608*01","cliId":"","pno":7574034385,"cno":7574034385,"email":"","ename":"","eno":"","pphy":"BRITT, CHARLENE MEBANE MD","ppno":7573636800,"pcpadd":"STE 100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23455-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079023,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D72.829","E11.65","L60.8","C7A.8","K76.0","N83.202","K80.20","Z90.81","Z90.411","N20.0","M25.50","E78.5","I21.02","I10.","I71.4","R25.2","E86.0","E11.3399","G47.09","D3A.8","R16.0","K57.30","I77.6","K86.89","Z72.0","R10.84","C25.1","E78.2","E11.9","F17.210","E78.00","I25.2","Z91.048","Z95.5","Z82.49","Z71.6","Z79.82","Z79.899","Z79.84","Z09.","E11.69","E04.1","I25.119","N92.6","K13.79","R20.0","R91.8","Z23.","R18.8","R65.10","E07.9","Z83.3","E10.319","R74.8","E78.6","I25.10","F41.9","I21.11","I21.09","R79.89","I25.118","K44.9","K29.60","K82.4","T81.89XA","Z12.11","K59.00","R93.5","R10.31","R10.32","Z79.4","I70.0","N93.9","Z98.890","R50.9","Z12.39","Z11.4","D49.0","R22.1","R93.2","K29.70","K91.89","G47.00","K82.8","R53.83"],"date":["2022-02-27","2022-03-22","2022-03-22","2022-11-17","2023-03-08","2022-11-08","2023-02-17","2023-02-03","2022-11-08","2023-02-03","2022-05-13","2023-03-08","2023-03-08","2023-03-08","2022-08-29","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2023-02-03","2023-02-03","2023-02-03","2022-04-07","2022-02-24","2021-10-26","2021-10-24","2022-02-09","2023-03-02","2022-08-08","2022-02-24","2023-03-02","2022-02-24","2022-02-09","2022-03-23","2022-02-24","2022-02-09","2022-02-24","2022-02-09","2022-02-24","2022-03-04","2023-03-02","2022-11-02","2023-02-17","2021-03-03","2021-03-03","2021-03-03","2021-12-21","2023-02-17","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-04-01","2022-08-08","2021-03-05","2022-05-16","2022-03-23","2022-03-23","2022-03-23","2021-09-03","2021-09-03","2021-11-23","2021-11-23","2021-11-23","2022-02-25","2023-02-17","2022-08-08","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-12-07","2022-02-24","2023-02-16","2022-02-27","2023-02-17","2023-02-17","2023-02-16","2021-08-06","2021-10-25","2021-11-23","2022-02-24","2021-11-05","2021-11-23","2023-03-08"],"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":[["","65862035705","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","70010049105","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","00378395305","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","65862050220","AMOX\/K CLAV","TAB 500-125","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","52937000120","VASCEPA","CAP 1GM","120","Select","Select",""],["","00054050823","ICOSAPENT","CAP 1GM","120","Select","Select",""],["","31722088530","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","15","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","00002879759","HUMALOG MIX","INJ 75\/25KWP","3","Select","Select",""],["","00002823305","INSULIN LISP","INJ PROTAMIN","15","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","6","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00597015230","JARDIANCE","10 MG","5","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","65649040001","PLENVU","SOL ","3","Select","Select",""],["","57599740105","PRECISION","TES QID","300","Select","Select",""],["","00002823305","INSULIN LISPRO PROTAMINE MIX","75-25\/ML","15","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","30","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","100","Select","Select",""],["","31722088490","ROSUVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","6","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","90","Select","Select",""],["","43598083305","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","100","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":""}]}]}