{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES H GREGORY","gend":0,"add":"545 CHANTICLAR CTS","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1977-07-19","age":"","mstatus":"","insh":"2411132*01","cliId":"","pno":7573462785,"cno":7573462785,"email":"","ename":"","eno":"","pphy":"SRIVASTAVA, RAVI MD","ppno":7573454800,"pcpadd":"400 SENTARA CIR STE 320,","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Cardiology Specialists - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573454801,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K92.1","K92.0","N18.6","R11.2","K22.6","K92.2","Z01.810","I10.","Z99.2","D62.","I12.0","D63.8","K31.89","E83.52","E87.5","K29.70","F17.210","Z79.899","Z86.16","R42.","G89.18","Z48.89","Z20.822","I95.9","T82.591A","T82.858A","Z01.812","R23.1","R11.0","R11.11","T82.590A","E83.39","Z91.158","R94.31","Z86.39"],"date":["2021-10-21","2021-10-18","2023-08-31","2021-10-21","2021-10-21","2021-11-09","2021-11-29","2021-11-09","2023-08-31","2021-10-18","2023-04-18","2023-04-09","2021-10-19","2021-10-18","2023-06-26","2021-10-18","2023-04-18","2021-10-18","2021-10-18","2021-10-19","2021-12-07","2021-12-07","2021-12-03","2021-10-18","2022-01-14","2022-01-14","2021-12-03","2021-10-18","2021-10-18","2021-10-18","2022-01-14","2023-04-09","2023-04-18","2023-04-09","2023-04-18"],"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":[["","00406051201","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","16714071502","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","65862092127","SEVELAMER","TAB 800MG","360","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","43598036730","CINACALCET","TAB 30MG","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","60","Select","Select",""],["","60258016001","RENA-VITE","TAB ","90","Select","Select",""],["","60258016101","RENA-VITE RX","TAB ","30","Select","Select",""],["","51672130104","AMMONIUM LAC","CRE 0.12","280","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","49230064551","VELPHORO","500MG IRON","180","Select","Select",""],["","68382009405","CARVEDILOL","12.5 MG","60","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","43598036730","CINACALCET HCL","30 MG","30","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","65862092127","SEVELAMER CARBONATE","800 MG","270","Select","Select",""],["","00310111030","LOKELMA","10 G","20","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","53436008401","VELTASSA","8.4 GRAM","30","Select","Select",""],["","00406012301","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","65862092127","SEVELAMER TAB","800MG","270","Select","Select",""],["","16729044210","CINACALCET TAB","90MG","30","Select","Select",""],["","60258016001","RENA-VITE TAB","","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN CRE","2.5-2.5%","60","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","6","Select","Select",""],["","60258016101","RENA-VITE RX TAB","","30","Select","Select",""],["","49230064551","VELPHORO CHW","500MG","180","Select","Select",""],["","51672130104","AMMONIUM LAC CRE","12%","280","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","2","Select","Select",""],["","68645051654","AMLODIPINE TAB","10MG","90","Select","Select",""],["","68382009405","CARVEDILOL TAB","12.5MG","60","Select","Select",""],["","00054430129","FUROSEMIDE","80 MG","90","Select","Select",""],["","13811052501","TRIPHROCAPS","1 MG","30","Select","Select",""],["","31722052101","HYDRALAZINE HCL","50 MG","90","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":""}]}]}