{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELENA  R BROWN","gend":1,"add":"866 35TH ST APT B","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1987-11-01","age":"","mstatus":"","insh":"3634833*01","cliId":"","pno":7579071208,"cno":7579071208,"email":"","ename":"","eno":"","pphy":"BROWN, ASHANTA N NP","ppno":7577265000,"pcpadd":"200 EATON ST,","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23669-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Old Hampton","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7577265001,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R07.89","R11.2","F14.20","F10.20","F12.20","F15.20","F40.10","F31.9","G47.00","V62.84","F33.2","L92.3","N76.0","B96.89","Z11.3","N89.8","F41.0","F33.1","F43.9","NO DATA","E66.9","R00.2","K90.9","Z98.84","Z68.29"],"date":["2021-08-06","2021-08-06","2021-08-06","2022-03-21","2022-04-28","2022-03-21","2022-04-28","2022-02-01","2022-04-25","2022-04-25","2022-02-26","2022-03-03","2021-03-04","2021-03-04","2021-03-04","2022-04-08","2022-10-27","2021-08-31","2021-08-31","2021-08-31","2022-03-06","2022-10-27","2021-08-06","2021-07-13","2021-07-13","2021-07-13"],"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":[["","50111056101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","60505008302","PAROXETINE","TAB 20MG","30","Select","Select",""],["","68462010860","TOPIRAMATE","TAB 25MG","31","Select","Select",""],["","69315012710","FOLIC ACID","TAB 1000MCG","30","Select","Select",""],["","16729014501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","00115101003","BACLOFEN","TAB 10MG","40","Select","Select",""],["","30768015745","MELATONIN","TAB 5MG","2","Select","Select",""],["","00054017613","BUPRENORPHIN","SUB 2MG","30","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","20","Select","Select",""],["","68682045570","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","49348057308","SM NICOTINE","GUM 2MG","50","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","80681005000","DAILY-VITE","TAB ","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","00904699446","GAS RELIEF","CAP 125MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","12496120203","SUBOXONE","MIS 2-0.5MG","30","Select","Select",""],["","31604001281","B1","TAB 100MG","30","Select","Select",""],["","00904541501","MICONAZOLE 3","KIT COMBO PK","1","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","57664050389","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","59651017601","DOXEPIN HCL","CAP 75MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","55111053205","DIVALPROEX","CAP 125MG","60","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","21","Select","Select",""],["","40985022881","BIOTIN","TAB 800MCG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","00093031105","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","49348030539","MILK OF MAGN","SUS 1200\/15","355","Select","Select",""],["","80681016900","VITAMIN D","3 TAB 25MCG","30","Select","Select",""],["","80681014000","CALCIUM CITR","TAB 200MG","30","Select","Select",""],["","00135020001","ABREVA","CRE 0.1","2","Select","Select",""],["","70677005101","MAG CITRATE","SOL LEMON","296","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","6","Select","Select",""],["","69097083512","SERTRALINE TAB","100MG","30","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","30","Select","Select",""],["","14539067501","HYDROXYZ PAM CAP","50MG","30","Select","Select",""],["","12496120203","SUBOXONE MIS","2-0.5MG","30","Select","Select",""],["","43547034809","PAROXETINE TAB","20MG","30","Select","Select",""],["","69097012203","TOPIRAMATE TAB","25MG","60","Select","Select",""],["","49348057308","SM NICOTINE GUM","2MG","50","Select","Select",""],["","00115101003","BACLOFEN TAB","10MG","40","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","74312052802","MELATONIN SUB","10MG","30","Select","Select",""],["","00093224001","CEPHALEXIN TAB","500MG","20","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","16729014501","QUETIAPINE TAB","25MG","60","Select","Select",""],["","60505264907","TIZANIDINE CAP","4MG","21","Select","Select",""],["","80681008600","MELATONIN TAB","3MG","120","Select","Select",""],["","59651017601","DOXEPIN HCL CAP","75MG","30","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","00093031105","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","80681005000","DAILY-VITE TAB","","30","Select","Select",""],["","49348030539","MILK OF MAGN SUS","1200\/15","355","Select","Select",""],["","00054017613","BUPRENORPHIN SUB","2MG","30","Select","Select",""],["","31604001870","VITAMIN D TAB","1000UNIT","30","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","30","Select","Select",""],["","00228212750","CLONIDINE TAB","0.1MG","30","Select","Select",""],["","40985022881","BIOTIN TAB","800MCG","30","Select","Select",""],["","57664050389","TIZANIDINE TAB","4MG","2","Select","Select",""],["","00135020001","ABREVA CRE","10%","2","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","55111053205","DIVALPROEX CAP","125MG","60","Select","Select",""],["","00904699446","GAS RELIEF CAP","125MG","30","Select","Select",""],["","31604001281","B","1 TAB 100MG","30","Select","Select",""],["","80681014000","CALCIUM CITR TAB","200MG","30","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","21","Select","Select",""],["","70677005101","MAG CITRATE SOL LEMON","","296","Select","Select",""],["","69547035302","NARCAN SPR","","2","Select","Select",""],["","00904541501","MICONAZOLE","3 KIT COMBO PK","1","Select","Select",""],["","68682045570","METRONIDAZOL GEL","0.75%VAG","70","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":""}]}]}