{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHANEL BUTLER","gend":1,"add":"67 SYCAMORE AVE","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1993-03-02","age":"","mstatus":"","insh":"3286304*01","cliId":"","pno":7576046048,"cno":7576046048,"email":"","ename":"","eno":"","pphy":"WALLACE, DAVID M MD","ppno":7575422000,"pcpadd":"20209 SENTARA WAY STE 200,","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":"23314-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - St. Luke's","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575422001,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","K21.9","F17.200","G47.00","M25.552","M62.81","R11.2","R10.13","Z00.00","Z23.","Z71.85","Z71.89","Z13.6","K20.0","E44.1","E55.9","J30.89","R06.2","R10.9","R13.10","R63.0","K44.9","K31.89","F43.12","T74.21XA","E87.6","U07.1","J30.9","J37.0","J20.9","H66.91","F17.210","M26.623","R03.0","R19.7","K58.9","Z79.52","Z79.899","Z86.2","N89.8","R11.10","J45.909","R09.81","J30.1"],"date":["2021-01-01","2023-07-05","2023-03-09","2021-01-05","2021-02-19","2021-02-19","2023-05-31","2023-05-31","2022-06-03","2022-06-03","2022-09-14","2022-06-03","2022-06-03","2023-07-05","2022-06-03","2022-06-03","2023-03-09","2023-03-09","2021-06-03","2021-06-03","2021-02-18","2021-02-18","2021-02-18","2022-07-13","2022-03-23","2022-03-23","2022-09-14","2023-07-05","2023-07-05","2022-09-07","2022-09-07","2023-05-31","2023-07-05","2021-06-03","2022-03-23","2023-05-31","2022-09-18","2023-05-31","2022-09-18","2022-09-18","2023-05-31","2022-09-07","2022-09-07","2023-07-19"],"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":[["","68462034690","LEVOCETIRIZI TAB","5MG","30","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","30","Select","Select",""],["","61314030802","AZELASTINE DRO","0.05%","12","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00472037915","CLOTRIM\/BETA CRE DIPROP","","15","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00173072020","FLOVENT HFA AER","220MCG","12","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","00378334053","XULANE DIS","150-35","3","Select","Select",""],["","70700010918","CLOBETASOL CRE","0.05%","45","Select","Select",""],["","65162052110","PROMETHAZINE TAB","25MG","12","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","43547028910","BUPROPION TAB","150MG SR","60","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","15","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","21","Select","Select",""],["","51224002250","AZITHROMYCIN TAB","250MG","4","Select","Select",""],["","10572010001","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","70954005920","PREDNISONE TAB","10MG","43","Select","Select",""],["","08373917700","VALVD HOLDNG MIS CHAMBER","","1","Select","Select",""],["","00536408501","PRENATAL TAB","28-0.8MG","30","Select","Select",""],["","31722072690","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","60505083305","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG\/0.3","2","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","20","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","68462034690","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","30","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","00536408501","PRENATAL VITAMINS","28MG-0.8MG","30","Select","Select",""],["","45802065087","LORATADINE","10 MG","30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","70069009101","AZELASTINE","DRO 0.0005","6","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00472037915","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","70700010918","CLOBETASOL","CRE 0.0005","45","Select","Select",""],["","51224002250","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","08373917700","VALVD HOLDNG","MIS CHAMBER","1","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","43","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","21","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":""}]}]}