{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALISHA  N KIRBY","gend":1,"add":"414 BRITNIE CTS HOMELESS","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1993-05-06","age":"","mstatus":"","insh":"2277344*01","cliId":"","pno":7577765197,"cno":7577765197,"email":"","ename":"","eno":"","pphy":"SALAZAR, JUAN S 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":"M4","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":["O02.1","Z3A.10","F31.9","Z11.3","Z11.4","Z32.02","N76.0","R76.0","T81.19XA","S80.812A","Z20.828","O23.41","T79.4XXA","R41.82","D57.3","F17.210","F20.9","F10.10","Z78.1","A59.9","U07.1","N93.9","D57.1","Z87.442","Z87.891","B34.9","D58.2","F25.1","J45.20","E55.9","F25.9","S06.0X0A","N93.8","Z13.9","Z79.899","Z88.8","Z91.040","N89.8","B96.89","K08.89","L02.92","Z71.9","I10.","Z88.1","Z91.013","Z91.018","Z32.00","Z28.310","Z88.3","Z20.822","R19.7","N89.9","L73.9","F25.0","R51.9","J40.","K03.81","O23.591","O99.611","O20.0","K64.4","Z3A.01","Z72.51","R40.20","V89.2XXA","Y92.414","F41.9","Z91.51","O20.9"],"date":["2021-03-10","2021-03-10","2022-10-23","2022-11-03","2022-05-31","2022-10-23","2022-06-30","2022-06-30","2022-07-10","2022-07-10","2021-09-12","2021-10-05","2022-07-10","2022-07-10","2023-02-27","2022-12-31","2022-10-23","2022-07-10","2022-07-10","2022-11-21","2022-12-31","2022-10-23","2022-03-21","2022-01-05","2022-03-21","2022-09-13","2022-10-18","2022-10-18","2022-10-18","2023-02-27","2023-04-03","2021-04-18","2021-04-18","2022-03-21","2022-03-21","2022-09-13","2022-09-13","2022-03-21","2022-06-22","2021-07-23","2021-12-08","2021-12-08","2022-06-22","2022-09-13","2022-09-13","2022-09-13","2022-06-22","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-11-03","2022-11-03","2023-03-06","2022-12-31","2021-09-12","2022-04-25","2021-01-23","2021-01-23","2021-01-23","2021-01-23","2022-10-23","2021-08-03","2022-07-10","2022-07-10","2022-07-10","2022-10-23","2022-10-23","2022-10-23"],"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":[["","68682045570","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","68462030929","NORGEST\/ETHI","TAB 0.25\/35","84","Select","Select",""],["","00054063905","METHYLERGON","TAB 0.2MG","4","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","30","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","57896010210","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00093227434","AMOX\/K CLAV","TAB 500-125","20","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68071152505","PROAIR HFA","AER ","8","Select","Select",""],["","59762305102","AZITHROMYCIN","POW 1GM PAK","1","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","6","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","64980042712","TINIDAZOLE","TAB 500MG","4","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","10","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","49483034001","ACETAMIN","TAB 325MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","80681017400","VITAMIN D","3 1250 MCG","12","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","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":""}]}]}