{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SAMOHTYELDUD","gend":0,"add":"GAIRRAC 941613 MR DR E","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1968-11-07","age":"","mstatus":"","insh":"1625110*92","cliId":"","pno":"12\/4081600-0","cno":"","email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":"757\/594-1850","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","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":["S63.613A","S63.615A","F41.1","F41.0","F43.23","M54.2","Z79.891","M47.812","M54.12","S43.432A","S46.012A","X50.0XXA","I65.23","R93.0","Z12.11","D12.3","D12.2","G47.33","G43.009","R20.2","R09.89","R05.","Z77.120","M77.12","M77.8","E34.8","I10.","M50.30","F41.9","Z95.1","M20.012","M48.02","M50.322","I67.82","M62.40","V58.89","G56.02","M25.512","M19.032","M67.442","W01.10XD","W23.1XXD","M77.11","M25.522","M25.521","R42.","R19.4","R13.10","R19.8","Z87.891","Z95.818","I25.810","E78.2"],"date":["2020-04-29","2020-04-29","2021-04-21","2021-04-21","2021-04-21","2021-04-23","2021-03-31","2021-04-23","2021-05-05","2021-06-23","2021-06-23","2021-06-23","2020-05-21","2020-05-21","2020-10-15","2020-10-15","2020-10-15","2021-04-02","2021-05-05","2020-09-30","2021-03-22","2021-03-22","2021-03-22","2021-05-14","2021-05-14","2020-04-30","2021-02-25","2020-04-30","2020-04-30","2020-04-30","2020-08-17","2020-05-13","2020-05-13","2020-05-21","2020-05-29","2020-05-29","2020-08-19","2021-05-12","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-09-15","2020-09-15","2020-09-15","2020-04-14","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2021-02-25","2021-02-25"],"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":[["","","AMITRIPTYLIN","TAB 25MG","","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","45","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","16729004617","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","59779060027","CVS","TAB 81MG EC","90","Select","Select",""],["","","BUSPIRONE","TAB 7.5MG","","Select","Select",""],["","49483048110","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","METHOCARBAM","TAB 750MG","","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","","ARTHRTS","TAB 650MG","","Select","Select",""],["","","ASPIR-LOW","TAB 81MG EC","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","00228255111","DICLOFENAC","TAB 75MG DR","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":""}]}]}