{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARISA L ADAMS","gend":1,"add":"4737 WINDERMERE CT APT 201","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1989-11-04","age":"","mstatus":"","insh":"2379283*01","cliId":"","pno":7573723060,"cno":7573723060,"email":"","ename":"","eno":"","pphy":"BAINES, ROBIN S MD","ppno":7578272550,"pcpadd":"3000 COLISEUM DR STE 205,","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Comprehensive Weight Loss Solutions - CarePlex","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8559397186,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F15.20","F14.20","F33.2","F33.1","R05.9","R06.2","R06.02","Z87.891","Z20.822","V23.87","A59.01","F19.90","O99.512","J45.901","E03.9","NO DATA","O99.012","F41.9","O99.282","O99.342","Z3A.25","Z82.49","Z83.3","Z87.442","O99.52","J45.21","Z34.92","Z3A.32","O99.519","J45.41","O26.893","J18.9","J45.902","F32.9","D50.9","Z79.899","E28.2","S29.011A","O9A.212","Z3A.26","J45.909","O82.","O66.40","Z3A.37","Z37.0","Z86.16","R53.83","R10.9","J06.9","E01.0","R59.0","R35.0","O21.9","O99.511","Z3A.01","J45.42","Z3A.27","V23.9","F19.10","Z3A.29","Z09.","Z30.2","Z30.017","R10.2","N83.01","Q61.3","Z98.891","F17.210","R30.0","O23.592","B96.89","O24.112","V23.5","Z3A.15","O26.892","N76.0","F11.20","R50.9","Z33.1","J45.51","G47.33","O26.891","J04.0","J98.8","B97.89","O47.03","O99.343","Z87.59","R60.1","H60.392","O23.42","Z3A.24","Z3A.36","J01.90","B37.0","K21.9","R06.83","H60.502","H62.42","B36.9","D64.9","R51.9","O99.513","N83.00","F15.23","I12.9","N18.9","R07.9","Z32.01","I08.0","G89.18","F31.81","F43.22","F15.21","Z01.419","E04.9","Z30.432","Z31.69","E66.9","F15.10","O99.324","O99.02","O16.4","O99.213","O99.013","J20.9","O99.284","O61.0","Z39.1","Z34.82","Z34.83","Z3A.31","O99.891","Z87.51","O99.283","Z3A.35","Z87.01","R22.0"],"date":["2022-02-21","2022-09-12","2022-09-12","2021-10-05","2022-01-02","2022-08-24","2023-03-23","2022-10-31","2022-12-30","2022-08-24","2022-03-30","2022-03-30","2022-03-30","2022-08-24","2023-03-23","2022-10-31","2022-10-31","2022-08-16","2022-12-30","2022-08-07","2022-08-24","2022-08-16","2022-08-07","2022-08-07","2022-12-30","2022-10-31","2022-08-11","2022-08-07","2022-10-05","2022-08-10","2022-11-05","2022-08-11","2022-08-16","2022-08-18","2022-08-16","2022-10-31","2022-12-30","2022-10-26","2022-08-16","2022-08-16","2022-08-18","2022-11-06","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2021-11-15","2021-11-15","2022-09-24","2022-08-05","2022-02-02","2022-02-02","2022-02-02","2022-04-04","2022-04-04","2022-04-04","2022-08-17","2022-08-24","2022-09-12","2022-09-12","2022-09-12","2022-11-28","2022-11-28","2023-02-20","2022-12-30","2022-12-30","2022-12-30","2022-12-30","2023-03-23","2022-12-30","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-06-14","2022-08-05","2022-08-17","2022-11-01","2022-10-31","2022-04-04","2022-08-06","2022-08-06","2022-08-06","2022-10-05","2022-10-26","2022-10-05","2022-10-05","2022-06-20","2022-08-05","2022-08-05","2022-11-05","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-06-17","2022-06-19","2022-06-19","2022-08-07","2022-08-07","2022-10-31","2022-12-30","2022-01-05","2022-01-05","2022-01-05","2022-08-07","2022-03-21","2022-11-03","2022-11-06","2021-04-22","2021-04-22","2021-04-22","2022-01-03","2022-01-03","2022-01-03","2022-01-03","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-11-04","2022-11-30","2022-11-30","2022-11-30","2022-09-24","2022-09-24","2022-09-24","2022-10-26","2022-10-26","2022-10-26","2022-10-26"],"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":[["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","50383074120","ALBUTEROL","NEB 0.005","20","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","11917017096","VITAMIN D3","CAP 2000UNIT","60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","52817081615","ACETIC ACID","SOL 2% OTIC","15","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","69238161606","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","66993013697","FLUTIC\/VILAN","INH 200-25","60","Select","Select",""],["","76204010025","IPRATROPIUM","SOL 0.02%INH","62","Select","Select",""],["","27808008602","HYD POL\/CPM","SUS 10-8\/5ML","70","Select","Select",""],["","73796045801","COMP AIR","MIS COMP\/NEB","1","Select","Select",""],["","11917017126","IRON","TAB 325MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","11","Select","Select",""],["","51224002250","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","00054001925","PREDNISONE","50 MG","4","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00173088210","BREO ELLIPTA","INH 200-25","60","Select","Select",""],["","74312001707","ASCORBIC ACD","TAB 1000MG","30","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00597008717","ATROVENT HFA","AER 17MCG","13","Select","Select",""],["","11917011818","D3","CAP 2000UNIT","60","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","51672130200","TERCONAZOLE","CRE 0.008","20","Select","Select",""],["","58657050916","GUAIFENESIN","LIQ 100\/5ML","200","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","27","Select","Select",""],["","43547028110","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","11917020796","VITAMIN C","TAB 1000MG","30","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","120","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","60","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","40","Select","Select",""],["","00472037945","CLOTRIM\/BETA","CRE DIPROP","90","Select","Select",""],["","00536118297","MUCUS&CHST","LIQ 100\/5ML","236","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","76204020025","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","00363853020",""," ","60","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","11917017096","VITAMIN D","3 CAP 2000UNIT","60","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","4","Select","Select",""],["","68180035302","SERTRALINE TAB","100MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","51672130200","TERCONAZOLE CRE","0.8%","20","Select","Select",""],["","00591544210","PREDNISONE TAB","10MG","5","Select","Select",""],["","52817081615","ACETIC ACID SOL","2% OTIC","15","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","11","Select","Select",""],["","27808008602","HYD POL\/CPM SUS","10-8\/5ML","70","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","76204010001","IPRATROPIUM SOL","0.02%INH","75","Select","Select",""],["","73796045801","COMP AIR MIS COMP\/NEB","","1","Select","Select",""],["","00781618667","CIPRO\/DEXA SUS","0.3-0.1%","8","Select","Select",""],["","43547028110","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","58657050916","GUAIFENESIN LIQ","100\/5ML","200","Select","Select",""],["","76204060030","IPRATROPIUM\/ SOL ALBUTER","","90","Select","Select",""],["","00173088210","BREO ELLIPTA INH","200-25","60","Select","Select",""],["","69238161606","OFLOXACIN DRO","0.3%OTIC","10","Select","Select",""],["","66993013697","FLUTIC\/VILAN INH","200-25","60","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","11917011818","D","3 CAP 2000UNIT","60","Select","Select",""],["","00597008717","ATROVENT HFA AER","17MCG","13","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","00597010061","SPIRIVA SPR","2.5MCG","4","Select","Select",""],["","00536118297","MUCUS&CHST LIQ","100\/5ML","236","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","30","Select","Select",""],["","57237002801","AMOXICILLIN TAB","500MG","27","Select","Select",""],["","51224002250","AZITHROMYCIN TAB","250MG","4","Select","Select",""],["","11917020796","VITAMIN C TAB","1000MG","30","Select","Select",""],["","45802065087","LORATADINE TAB","10MG","30","Select","Select",""],["","42806016105","HYDROXYZ HCL TAB","50MG","30","Select","Select",""],["","00472037945","CLOTRIM\/BETA CRE DIPROP","","45","Select","Select",""],["","11917017126","IRON TAB","325MG","90","Select","Select",""],["","74312001707","ASCORBIC ACD TAB","1000MG","30","Select","Select",""],["","00904672059","ACETAMIN TAB","500MG","60","Select","Select",""],["","64380080707","IBUPROFEN TAB","800MG","40","Select","Select",""],["","66689000816","NYSTATIN SUS","100000","473","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","90","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","32","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","30","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":""}]}]}