{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEX FREEMAN","gend":0,"add":"111 E CUMMINGS AVE","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1979-04-06","age":"","mstatus":"","insh":"2228255*01","cliId":"","pno":7579560868,"cno":7579560868,"email":"","ename":"","eno":"","pphy":"FRISCO, SHAWNITA A MD","ppno":7578272025,"pcpadd":"4001 COLISEUM DR STE 300,","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572759802,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.30","R19.7","R11.0","M79.604","G35.","R26.89","E11.9","Z12.11","Z12.5","E11.65","I10.","Z51.81","Z20.822","R53.83","Z79.4","F32.1","F41.1","R06.02","J06.9","I48.0","Z79.899","Z79.01","Z88.8","R07.9","R91.1","N40.1","R31.0","K57.92","F33.1","E66.01","Z68.36","Z20.828","M54.41","M62.838","G89.29","M21.379","M62.89","NO DATA","Z86.39","Z86.69","Z86.79","Z01.00","L30.9","G47.33","R26.9","R25.2","R53.82","F10.10","G95.9","L50.9","T78.40XA","I49.9","R10.31","R19.4","R94.5","M10.372","K27.9","Z11.3","N34.1","Z00.00","F17.290","R76.8","E11.69","E78.5","M62.830","E66.09","M79.672","K59.01","F34.1","F06.4","F33.2","R21.","Z23.","B35.3","Z72.0","Z13.29","L50.0","F17.210","E66.9","Z68.35","R07.89","K57.90","R10.9","N31.9","N39.41","R39.12","R39.14","B35.4","R05.","R39.198","M79.10","J98.01","J20.8","R52.","Z20.2","Z13.1","I48.91","S80.212A","G47.30","Z87.891","M54.9","F09.","R44.9"],"date":["2021-02-06","2021-02-06","2021-02-06","2021-04-20","2023-09-07","2021-04-20","2022-12-18","2021-07-07","2022-02-08","2023-07-18","2023-09-07","2022-05-25","2022-01-05","2021-07-07","2023-07-18","2023-07-16","2021-12-12","2021-12-20","2022-09-29","2023-01-12","2021-12-20","2022-12-18","2022-09-02","2021-12-20","2022-02-08","2022-02-08","2022-02-08","2023-01-12","2023-01-12","2023-01-12","2023-01-12","2021-06-22","2023-01-24","2023-07-25","2023-01-24","2022-06-27","2022-06-27","2023-04-18","2022-06-27","2022-06-27","2022-06-27","2022-09-13","2022-09-13","2023-07-25","2023-07-25","2022-01-03","2023-07-25","2022-01-03","2022-01-03","2022-09-02","2022-09-02","2022-12-18","2023-02-03","2023-02-03","2023-02-03","2021-02-19","2021-04-05","2023-04-12","2022-01-15","2022-06-13","2022-06-13","2022-06-13","2023-07-18","2023-07-18","2022-10-25","2022-10-25","2021-03-12","2023-04-12","2021-11-15","2021-11-15","2021-02-09","2022-09-02","2022-05-25","2022-05-25","2023-07-18","2022-05-25","2022-09-02","2022-09-02","2022-09-02","2022-09-02","2023-04-18","2021-01-26","2021-01-26","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-04-27","2021-06-27","2021-04-05","2021-06-22","2021-06-27","2021-06-27","2022-11-10","2023-03-29","2023-07-18","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2023-09-20","2023-09-07"],"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":[["","00169369619","NOVOLOG MIX","INJ FLEXPEN","15","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","180","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","68546031730","COPAXONE","INJ 20MG\/ML","30","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","6","Select","Select",""],["","01490032642","PEPTO-BISMOL","CHW 262MG","48","Select","Select",""],["","00003089421","ELIQUIS","5 MG","180","Select","Select",""],["","37000045504","PRILOSEC OTC","TAB 20MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","60","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","72888001101","BACLOFEN","20 MG","60","Select","Select",""],["","68382056501","METOPROL SUC","TAB 50MG ER","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","68180013501","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","00363410040","STOOL SOFTEN","CAP 100MG","30","Select","Select",""],["","00378696093","GLATIRAMER","INJ 20MG\/ML","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","62332003731","LAMOTRIGINE","TAB 25MG","15","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","15","Select","Select",""],["","73070020315","INS ASP PROT","INJ FLEXPEN","15","Select","Select",""],["","69097067905","PREGABALIN","CAP 75MG","120","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","43598044774","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","14","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","43598057430","TADALAFIL","TAB 10MG","20","Select","Select",""],["","68180045901","AMLOD\/BENAZP","CAP 5-20MG","90","Select","Select",""],["","00713022515","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","20","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","42192033901","HYOSCYAMINE SULFATE","0.125 MG","120","Select","Select",""],["","45963067711","METOPROLOL SUCCINATE","100 MG","30","Select","Select",""],["","00143992801","CIPROFLOXACIN HCL","500 MG","20","Select","Select",""],["","69315090505","LORAZEPAM","1 MG","2","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","30","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00904699860","DOCUSATE SODIUM","100 MG","90","Select","Select",""],["","68180013501","ESCITALOPRAM TAB","10MG","90","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","30","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","180","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","72888001101","BACLOFEN TAB","20MG","60","Select","Select",""],["","00169369619","NOVOLOG MIX INJ FLEXPEN","","15","Select","Select",""],["","68382056501","METOPROL SUC TAB","50MG ER","30","Select","Select",""],["","00378395105","ATORVASTATIN TAB","20MG","14","Select","Select",""],["","00093321930","KETOCONAZOLE CRE","2%","60","Select","Select",""],["","68382013201","TAMSULOSIN CAP","0.4MG","90","Select","Select",""],["","00363410040","STOOL SOFTEN CAP","100MG","30","Select","Select",""],["","43598057430","TADALAFIL TAB","10MG","20","Select","Select",""],["","69097067905","PREGABALIN CAP","75MG","120","Select","Select",""],["","00172392570","DIAZEPAM TAB","2MG","60","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","43598044774","NICOTINE TD DIS","14MG\/24H","28","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","73070010315","INSULIN ASPA INJ FLEXPEN","","15","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","00713022515","TRIAMCINOLON CRE","0.1%","45","Select","Select",""],["","68180045901","AMLOD\/BENAZP CAP","5-20MG","30","Select","Select",""],["","43598081115","CETIRIZINE TAB","10MG","20","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","6","Select","Select",""],["","69238126601","OSELTAMIVIR CAP","75MG","10","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":""}]}]}