{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS  C MARITS","gend":0,"add":"4540 DUFFY DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1977-10-21","age":"","mstatus":"","insh":"2357840*01","cliId":"","pno":7575737705,"cno":7575737705,"email":"","ename":"","eno":"","pphy":"ALBALA, TODD MD","ppno":7573956630,"pcpadd":"1080 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - 1080 Bldg","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079074,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F31.89","Q24.8","F33.2","I48.92","F33.1","F51.01","Q20.3","Q21.0","Q25.6","Z95.2","F60.7","F31.9","Z51.81","F33.9","Q24.6","R00.1","L81.4","L24.9","D22.5","D22.72","I48.0","Z87.74","F43.12","F41.0","R53.83","F32.9","G47.00","Q24.9","F41.9","I45.10","I51.7","Z13.6","L64.8","Z95.4","Z79.82","I77.810","NO DATA","I47.1","F99.","L70.0"],"date":["2023-04-18","2021-02-12","2021-09-21","2023-04-11","2022-10-07","2023-04-18","2023-01-31","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2022-03-11","2021-04-22","2021-06-10","2021-08-05","2021-08-05","2021-07-21","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2022-05-02","2023-03-14","2023-04-18","2023-04-18","2021-05-13","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-05-13","2021-05-13","2021-07-21","2023-03-17","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-17"],"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":[["","13668013710","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00228202910","ALPRAZOLAM","0.5 MG","30","Select","Select",""],["","33342030011","ESZOPICLONE","2 MG","30","Select","Select",""],["","62559038101","FLECAINIDE","TAB 100MG","60","Select","Select",""],["","27241005203","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","57237006130","FINASTERIDE","1 MG","90","Select","Select",""],["","52187053301","HC PRAMOXINE","CRE 2.5-1%","28","Select","Select",""],["","42806066301","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","90","Select","Select",""],["","51991081701","PROPRANOLOL","CAP 60MG ER","90","Select","Select",""],["","51991000633","DESVENLAFAX","TAB 25MG ER","30","Select","Select",""],["","33332032101","AFLURIA QUAD","INJ 2021-22","0","Select","Select",""],["","42571025101","CLINDAMYCIN","CAP 150MG","8","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","4","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00172392660","DIAZEPAM","5 MG","90","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","21922003601","CLINDAMYCIN PHOSPHATE","1 %","60","Select","Select",""],["","68180059306","DESVENLAFAXINE SUCCINATE ER","100 MG","60","Select","Select",""],["","53746064201","FLECAINIDE ACETATE","100 MG","180","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":""}]}]}