{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENDRA  N MILES","gend":1,"add":"3262 GREEN LAKES DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1981-12-12","age":"","mstatus":"","insh":"6109845*01","cliId":"","pno":7575536401,"cno":7575536401,"email":"","ename":"","eno":"","pphy":"SULLIVAN, KAREN A MD","ppno":7574137600,"pcpadd":"SUITE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23464-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079054,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L81.9","Z71.9","Z01.812","C50.912","Z17.0","Z20.822","Z90.13","Z98.890","Z42.1","Z68.41","E11.9","E66.01","NO DATA","Z85.3","K21.9","F41.9","Z86.32","Z28.310","Z82.49","Z83.3","Z82.5","Z82.3","Z80.0","Z80.3","Z83.438","D05.12","N64.89","R92.1","N64.1","R92.0","D05.10","U07.1","E11.22","M21.6X1","M21.6X2","R42.","K76.0","R16.0","Z01.419","M25.461","B37.3","Z00.00","Z23.","E78.2","Z48.89","M25.571","M79.671","G89.29","E11.69","L30.4","F32.1","E78.5","Z15.01","I77.4","I70.90","K44.9","K57.90","Z01.810","R10.32","L24.9","B35.3","L85.3","M25.561","G47.33"],"date":["2021-03-16","2021-03-16","2023-01-07","2023-01-13","2023-01-13","2022-04-29","2022-10-17","2022-12-22","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-02-21","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-03-10","2023-02-08","2022-01-19","2022-01-19","2022-02-11","2022-04-29","2022-12-29","2023-02-21","2023-02-21","2023-02-21","2022-07-11","2022-12-23","2022-09-09","2022-08-11","2021-12-23","2022-02-02","2022-11-02","2022-11-02","2022-11-02","2023-02-06","2021-01-25","2021-01-25","2021-01-25","2022-07-27","2022-07-27","2023-01-13","2022-07-27","2022-01-25","2022-12-23","2022-12-23","2022-12-23","2022-12-23","2023-01-13","2023-02-23","2022-02-24","2022-02-24","2022-02-24","2021-10-13","2021-10-13"],"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":[["","00555904558","AVIANE","TAB ","28","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","63646001004","KETOCONAZOLE","2 %","120","Select","Select",""],["","00713063437","MOMETASONE","CRE 0.001","45","Select","Select",""],["","16714039102","CEFDINIR","CAP 300MG","28","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","20","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","14","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","1","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00904679480","ASPIRIN","81 MG","14","Select","Select",""],["","70377000812","ROSUVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","68645058259","METFORMIN HCL","500 MG","60","Select","Select",""],["","16714020030","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","30","Select","Select",""],["","70010016305","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","13668001990","VENLAFAXINE HCL ER","75 MG","30","Select","Select",""],["","00093314701","CEPHALEXIN","500 MG","20","Select","Select",""],["","67877041301","METFORMIN HCL ER","500 MG","90","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","20","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":""}]}]}