{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANNIKWA HOLLOWAY","gend":1,"add":"7039 SEWELLS POINT RD APT F","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1992-08-05","age":"","mstatus":"","insh":"2449218*01","cliId":"","pno":7578169017,"cno":7578169017,"email":"","ename":"","eno":"","pphy":"FRANK, JANINE M MD","ppno":"","pcpadd":"4124 CHESAPEAKE SQUARE BLVD STE 103","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Chesapeake Square","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576738291,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.0","B20.","R05.","R06.00","J02.9","Z21.","M54.6","NO DATA","O98.713","O36.5930","Z3A.36","Z37.0","G62.9","R63.6","F39.","D57.3","F33.9","M54.9","D64.9","H04.123","H10.13","Z23.","Z20.822","Z79.899","O98.712","F31.9","Z3A.15","Z13.220","Z11.59","Z11.1","S05.02XA","R68.89","H53.8","O26.891","Z32.01","Z3A.01","B00.9","V23.9","E46.","G89.29","R11.0","O98.719","R53.82","K21.9","R07.89","Z3A.33","Z68.1","O99.891","O99.613","R79.89","R00.0","R06.02","M54.89","R05.9","O99.013","D50.9","D57.1","Z83.2","U07.1","O41.03X0","O98.72","O99.02","O98.32","O98.52","O99.344","A60.09","O99.892","R03.0","G89.18","H10.32","H54.7","Z97.3","H57.89","M41.9","R10.13"],"date":["2022-04-27","2023-03-27","2021-06-22","2021-06-22","2022-03-01","2022-06-23","2022-06-02","2023-03-30","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-05-11","2022-10-12","2022-05-11","2022-10-12","2021-05-19","2022-09-22","2021-06-22","2021-07-08","2021-07-08","2021-10-12","2022-03-01","2023-03-27","2022-05-19","2022-10-12","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2021-07-08","2021-07-08","2021-07-08","2022-03-28","2022-03-28","2022-03-28","2022-04-06","2022-04-06","2022-06-23","2022-06-23","2022-03-28","2022-10-13","2022-06-23","2023-03-27","2022-09-22","2022-09-22","2022-06-13","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-10-12","2022-09-22","2022-09-22","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-14","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2023-03-27","2023-03-27"],"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":[["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","13107003234","MIRTAZAPINE","TAB 45MG","30","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00363023820","STOOL SOFTNR","CAP 100MG","30","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","3","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","61958200201","DESCOVY","200MG-25MG","90","Select","Select",""],["","49702022813","TIVICAY","50 MG","90","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","30","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","473","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","00245010811","FERROUS SULF","TAB 325MG EC","180","Select","Select",""],["","11917012699","B-12","SUB 5000MCG","90","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","0","COMPOUND"," ","30","Select","Select",""],["","65162069388","ATOVAQUONE","SUS 750\/5ML","300","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00904720660","SIMETHICONE","CHW 80MG","60","Select","Select",""],["","11917015670","PRENATL MULT","","30","Select","Select",""],["","80681013800","CALCIUM\/D3","TAB 600MG","60","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","15","Select","Select",""],["","54838056670","LAMIVUDINE","SOL 10MG\/ML","20","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","65862005724","NEVIRAPINE","SUS 50MG\/5ML","60","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","68180087673","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","63044015001","PRENATAL VIT","TAB LOW IRON","30","Select","Select",""],["","65862004824","ZIDOVUDINE","SYP 50MG\/5ML","39","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","66689030516","SUCRALFATE","1 G\/10 ML","414","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","64380016001","MEGESTROL ACETATE","400MG\/10ML","600","Select","Select",""],["","16714069301","FLUCONAZOLE","200 MG","19","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":""}]}]}