{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN WIGGINS","gend":1,"add":"1090 FAIRGROUNDS LN","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1968-01-01","age":"","mstatus":"","insh":"2372814*01","cliId":"","pno":7579181531,"cno":7579181531,"email":"","ename":"","eno":"","pphy":"K C, RADHA MD","ppno":7572615910,"pcpadd":"850 KEMPSVILLE RD STE 200A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Kempsville","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574660321,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.8","Z79.4","E11.65","J45.20","E11.9","I10.","Z79.899","Z86.16","R06.00","M25.561","M25.562","E78.5","M06.09","D84.9","E83.42","E55.9","J98.4","Z12.31","R07.89","Z79.84","H04.123","Z09.","Z87.81","M06.9","E66.9","M15.9","R07.9","Z82.49","Z86.39","J45.909","Z87.11","Z98.84","K21.9","L30.4","Z79.1","Z91.040","Z88.2","L29.9","W57.XXXA","J40.","M17.0","U07.1","Z20.822","R92.8","I49.1","R06.02","Z01.411","N76.0","B96.89","L81.0","J06.9","Z23.","Z00.00","F41.9","E11.40","M20.11","M20.12","M20.41","M20.42","L84.","I11.9"],"date":["2022-02-28","2022-02-28","2023-02-15","2023-01-16","2023-01-16","2023-01-16","2021-10-27","2023-03-30","2023-02-15","2022-08-24","2022-08-24","2023-01-16","2023-01-16","2023-01-16","2023-01-16","2023-01-16","2023-01-16","2023-01-16","2023-02-15","2021-10-27","2021-03-29","2021-08-03","2021-08-03","2021-10-27","2021-08-03","2022-03-17","2023-03-30","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-11-28","2021-11-28","2021-12-19","2022-08-24","2022-11-12","2021-03-30","2021-10-11","2021-10-27","2023-03-30","2022-07-12","2022-07-12","2022-07-12","2022-02-23","2022-06-29","2022-10-13","2022-04-13","2022-04-13","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-03-30"],"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":[["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","69238131209","PREGABALIN","75 MG","60","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","60","Select","Select",""],["","58406003204","ENBREL SRCLK","INJ 50MG\/ML","4","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","57237022501","RAMIPRIL","10 MG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","62088000031","INPEN 100EL","MIS BLUE","1","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00002751659","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","60","Select","Select",""],["","00093506001","HYDROXYZ HCL","TAB 10MG","30","Select","Select",""],["","58657012012","MAG OXIDE","TAB 400MG","180","Select","Select",""],["","80777027315","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","51991084716","BROM\/PSE\/DM","SYP ","100","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","4","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00603533815","PREDNISONE","10 MG","21","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","69367027204","CODEINE\/GG","SOL 10-100\/5","100","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","9","Select","Select",""],["","00069110120","PAXLOVID","TAB 150-100","20","Select","Select",""],["","27808008601","HYD POL\/CPM","SUS 10-8\/5ML","115","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","70010049101","METFORMIN HCL ER","500 MG","180","Select","Select",""],["","58406003204","ENBREL SURECLICK","50MG\/ML(1)","4","Select","Select",""],["","24689013201","MAGNESIUM OXIDE","400 MG","180","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","55111017915","TIZANIDINE HCL","2 MG","60","Select","Select",""],["","59267030401","PFIZER COVID BIVAL (","12Y UP)EUA 30 MCG\/0.3","0.3","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","60","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","65862051330","PIOGLITAZONE HCL","30 MG","90","Select","Select",""],["","00597030045","SYNJARDY XR","12.5-1000","180","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","300","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","300","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":""}]}]}