{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   EILSELERTTEMDA ","gend":1,"add":"ALPNEERG 2745502 TPA DR NI","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1985-10-03","age":"","mstatus":"","insh":"0227110*18","cliId":"","pno":"13\/0744449-8","cno":"","email":"","ename":"","eno":"","pphy":"MEBRAHTU, SEMRET T MD","ppno":"757\/395-6900","pcpadd":"184B LASKIN RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.1","F41.1","F90.0","Z63.4","G47.33","Z82.0","E55.9","E66.3","K08.89","Z68.28","Z20.828","A08.4","Z86.39","R06.83","R06.81","R40.0","R53.83","Z72.821","G47.00","G47.8","R79.0","E11.9","L84.","F34.1","T75.3XXA","Z30.09","Z11.3","Z30.430","Z32.02","Z00.00","E78.5","G47.30","Z13.21","J30.9","R05.","R09.82","J37.0","K21.9","J30.1","Z03.818","Z79.84","Z79.899","Z88.8","E78.2","R20.2","F98.8","Q14.1"],"date":["2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-05-08","2020-03-11","2020-03-11","2020-03-04","2020-03-04","2020-03-04","2020-06-07","2020-03-04","2020-06-07","2020-03-04","2020-03-04","2021-11-17","2020-06-29","2020-07-27","2020-01-23","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-03-17","2020-06-09","2020-03-17","2020-03-17","2020-06-09","2020-06-09","2020-05-25","2020-06-29","2020-07-27","2020-06-29","2021-05-08","2021-11-17","2020-06-07","2020-06-07","2019-12-09","2019-12-09","2019-12-09","2021-11-17"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","","LOSARTAN","TAB 25MG","","Select","Select",""],["","","VICTOZA","INJ 18MG\/3ML","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","00363017508","PAIN","TAB 500MG","21","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","","SCOPOLAMINE","DIS 1MG\/3DAY","","Select","Select",""],["","","TRANSDERM","DIS 1MG\/3DAY","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","OZEMPIC","INJ 2\/1.5ML","","Select","Select",""],["","","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","","SUDOGEST","TAB 30MG","","Select","Select",""],["","","WAL-PHED","TAB 30MG","","Select","Select",""],["","","BD  PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","AMPHET\/DEXTR","TAB 10MG","","Select","Select",""],["","","FLUNISOLIDE","SPR 0.00025","","Select","Select",""],["","","TRANSDERM-SC","DIS 1.5MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","NASALIDE","SPR 0.00025","","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","","FEXOFENADINE","TAB 180MG","","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","42","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","30","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":""}]}]}