{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLETHIA FROST","gend":1,"add":"3342 BANGOR CRES","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1980-01-02","age":"","mstatus":"","insh":"5268354*01","cliId":"","pno":7575353667,"cno":7575353667,"email":"","ename":"","eno":"","pphy":"TYNES-MCCRAY, WANDA J NP","ppno":7579838600,"pcpadd":"SUITE 200 114 N MAIN STREET,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Belle Harbour","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579341660,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K91.2","E66.9","R73.01","E16.1","Z98.84","Z68.33","H40.1132","L50.9","L50.3","L29.9","F43.21","R30.0","N89.8","E04.9","R87.811","R20.0","R20.2","G56.03","R03.0","E66.01","Z20.828","H40.1131","H40.033","H40.20X1","M20.41","B35.1","L60.8","B35.3","B18.1","B37.3","A60.9","M25.512","M62.81","Z68.36","M20.42","B34.9","U07.1","F32.1","F41.9","Z01.419","M76.62","M25.572","L70.0","L91.8","Z71.9","Z92.29","J01.90","Z20.822","Z01.411","N30.00","E04.2"],"date":["2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2022-01-17","2023-04-26","2023-04-26","2023-04-26","2023-08-22","2023-04-24","2023-08-18","2023-04-24","2023-04-24","2021-04-22","2021-04-22","2021-05-03","2021-12-16","2021-12-16","2021-12-21","2023-06-26","2021-04-12","2021-04-12","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2022-03-08","2022-04-01","2022-04-01","2023-05-02","2023-05-02","2021-04-05","2021-10-19","2021-12-21","2021-12-21","2022-04-21","2022-04-21","2021-11-08","2021-12-05","2021-12-05","2023-04-03","2022-01-18","2023-04-03","2022-01-19","2022-03-02","2022-12-08","2023-03-27","2023-08-18","2023-05-30"],"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":[["","45802073684","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","53746051501","SPIRONOLACT","TAB 100MG","30","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","60","Select","Select",""],["","00078094640","TRAVATAN Z","0.004 %","2.5","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00363049539","WAL-ZYR","TAB 10MG","60","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","00378427577","VALACYCLOVIR","500 MG","90","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","60505059304","TRAVOPROST","DRO 0.00004","5","Select","Select",""],["","45802073684","CLINDAMYCIN PHOS-BENZOYL PEROX","1.2(1)%-5%","45","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","30","Select","Select",""],["","53746051501","SPIRONOLACTONE","100 MG","90","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","13811071910","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","4","Select","Select",""],["","45802073684","CLINDAMY\/BEN GEL","1.2-5%","45","Select","Select",""],["","53746051501","SPIRONOLACT TAB","100MG","30","Select","Select",""],["","43598081115","CETIRIZINE TAB","10MG","60","Select","Select",""],["","00078094640","TRAVATAN Z DRO","0.004%","2","Select","Select",""],["","00363049539","WAL-ZYR TAB","10MG","60","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","30","Select","Select",""],["","68180035302","SERTRALINE TAB","100MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR TAB","500MG","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA CRE DIPROP","","45","Select","Select",""],["","60505059304","TRAVOPROST DRO","0.004%","5","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","75834002012","VITAMIN D","3 1250 MCG","4","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":""}]}]}