{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KANDRA L MATHIS","gend":1,"add":"1430 GODFREY AVE","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1987-09-22","age":"","mstatus":"","insh":"5264367*01","cliId":"","pno":7573273115,"cno":7573273115,"email":"","ename":"","eno":"","pphy":"ONEAL, ALICIA D PA","ppno":7572615999,"pcpadd":"850 KEMPSVILLE RD STE 200B,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Walk In Care Kempsville","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574660321,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","N89.8","Z20.828","R10.30","N75.0","S39.012A","S16.1XXA","Z87.440","Z88.0","NO DATA","O99.891","H66.91","M54.2","M54.6","Z04.1","Z3A.01","F33.1","R31.9","Z11.52","J02.9","R68.89","R35.0","O23.591","B96.89","Z32.01","Z11.3","R10.2","N75.1","R00.0","R11.2","Z85.6","Z86.19","N90.89","N76.89","J34.89","R09.82","J98.8","Z20.822","U07.1","J45.909","Z79.899","R09.81","O21.9","O23.32","O99.512","J06.9","R07.9","K21.9","Z33.1","Z23.","O42.013","Z37.0","O99.52","Z3A.36","Z88.1","Z28.21","O42.913","R89.5","M25.561","L03.818","Z34.92","O26.891","Z01.419","R10.9","Z12.39","Z30.40","N92.0","R06.7","O9A.219","V23.87","Z3A.00","O21.0","R53.81","H92.03","R51.9","Z3A.13","Z92.21","O60.14X0","H66.93","B37.3","R31.29","R10.31","R10.32","R07.89","Z3A.18","O99.513","O9A.211","Z3A.32","F32.9","R05.","M62.40","B34.9","Z3A.20","O99.413","L29.3","Z30.2","F33.2","F41.1"],"date":["2023-05-31","2022-05-11","2023-03-08","2021-08-17","2021-12-02","2022-06-24","2022-06-28","2022-06-24","2023-02-08","2022-06-24","2023-01-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-07-08","2022-07-16","2022-10-05","2023-01-25","2023-01-25","2023-01-25","2021-01-05","2021-01-28","2021-01-28","2021-01-28","2022-03-02","2021-11-25","2021-11-29","2023-01-30","2021-11-25","2023-01-07","2021-11-25","2021-11-25","2021-12-15","2021-06-02","2021-06-02","2021-06-02","2022-10-04","2021-12-31","2023-02-08","2023-01-07","2023-01-30","2022-07-08","2022-10-04","2022-10-04","2023-03-08","2022-10-04","2022-11-15","2022-11-15","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2022-03-28","2022-10-15","2022-10-15","2022-10-15","2022-08-30","2021-08-20","2023-01-07","2021-08-20","2023-05-31","2021-10-06","2021-12-04","2022-06-28","2022-06-28","2022-06-28","2022-07-05","2022-07-05","2022-08-30","2022-08-30","2022-08-30","2022-10-04","2023-02-08","2021-01-11","2022-03-02","2022-10-04","2022-10-04","2022-10-04","2023-01-30","2022-10-04","2023-01-30","2022-06-28","2023-01-07","2021-03-04","2021-06-02","2021-08-17","2021-12-31","2022-10-15","2023-01-30","2023-05-31","2023-06-30","2023-09-19","2023-09-19"],"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":[["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","50383090110","HC\/ACET ACID","SOL OTIC","20","Select","Select",""],["","68462018449","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","58487003131","PRENATAL ONE","TAB DAILY","30","Select","Select",""],["","50383088915","ACETIC ACID","SOL 2% OTIC","15","Select","Select",""],["","65162027210","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","00904531360","PRENATAL","TAB 27-0.8MG","30","Select","Select",""],["","65162011510","HYDROCO\/APAP","TAB 7.5-325","6","Select","Select",""],["","65862001230","SERTRALINE","TAB 50MG","30","Select","Select",""],["","60505084805","AZELASTINE","SPR 0.0015","30","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","240","Select","Select",""],["","43598049501","NAPROXEN SOD","TAB 550MG","20","Select","Select",""],["","69751010012","PHEXXI","1.8-1-0.4%","180","Select","Select",""],["","42806071501","BENZONATATE","200 MG","21","Select","Select",""],["","65162046650","IBUPROFEN","800 MG","30","Select","Select",""],["","11822319860","RA SUPHEDRIN","TAB 30MG","24","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","10","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","8","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00054074287","ALBUTEROL","AER HFA","7","Select","Select",""],["","11822775350","RA TUSSIN DM","LIQ 100-10\/5","237","Select","Select",""],["","41100080217","CLARITIN-D","TAB 5-120MG","20","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","59746017506","PREDNISONE","20 MG","6","Select","Select",""],["","11822316450","LORATADINE","TAB 10MG","28","Select","Select",""],["","11822619080","ALLERGY\/CONG","TAB 5-120MG","20","Select","Select",""],["","73473030030","CLINDAMYCIN","GEL 0.01","30","Select","Select",""],["","64380079901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","11822145760","RA NASAL 12H","SPR 0.0005","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","55111011230","MOXIFLOXACIN","TAB 400MG","10","Select","Select",""],["","67877021620","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","45802075830","PROMETHAZINE","SUP 12.5MG","9","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","20","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","00536406301","CL PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00904674880","BISACODYL","TAB 5MG EC","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","73473030030","CLINDAMYCIN PHOSPHATE","1 %","30","Select","Select",""],["","51645075001","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","11822042030","SALINE NASAL SPRAY","0.65 %","45","Select","Select",""],["","50383077504","LIDOCAINE HCL VISCOUS","2 %","100","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","68001036500","METRONIDAZOLE","500 MG","14","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","8","Select","Select",""],["","00536132710","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","16571066401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","73473030370","METRONIDAZOL GEL","0.75%VAG","70","Select","Select",""],["","55111011230","MOXIFLOXACIN TAB","400MG","10","Select","Select",""],["","62332025118","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","31722072250","LEVOFLOXACIN TAB","500MG","7","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","15","Select","Select",""],["","65862018601","CLINDAMYCIN CAP","300MG","14","Select","Select",""],["","45802075830","PROMETHAZINE SUP","12.5MG","9","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","60","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","20","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","24","Select","Select",""],["","00536406301","CL PRENATAL TAB","28-0.8MG","30","Select","Select",""],["","67877021620","CEFUROXIME TAB","500MG","14","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","60432026415","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","73473030030","CLINDAMYCIN GEL","1%","30","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","00054074287","ALBUTEROL AER HFA","","7","Select","Select",""],["","57896010410","ACETAMINOPHE TAB","325MG","30","Select","Select",""],["","00904674880","BISACODYL TAB","5MG EC","30","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","28","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","10","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":""}]}]}