{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NYLETAKTTERRAG F","gend":1,"add":"OR ROLLECNAHC 131TTERRAG NASUS DA","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1999-06-12","age":"","mstatus":"","insh":"21000210*61","cliId":"","pno":"42\/7570814-0","cno":"757\/240-4180","email":"","ename":"","eno":"","pphy":"GLAVE, KRISTLE M NP","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Peninsula Towne","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["I10.","Z00.00","Z23.","Q87.19","F79.","L40.9","F50.89","R69.","T18.190A","R13.10","R11.11","R39.81","G82.22","M62.838","M24.572","K63.5","Z46.89","M24.571","K02.9","G80.8","R11.10","G82.20","R62.50","J98.4","K21.9","G47.33","H91.90","P07.38","Z98.890","Z87.821","T18.108A","R26.1","H65.112","J40.","R06.2","J01.90","T18.198A","Z76.89","Z13.0","Z13.1","Z01.419","Z30.40","J01.91"],"date":["2022-07-22","2022-08-10","2021-11-15","2022-06-13","2021-11-15","2021-11-15","2021-11-15","2020-04-02","2020-04-09","2020-04-09","2020-04-09","2020-04-06","2022-06-13","2021-06-14","2022-06-13","2020-04-09","2020-08-24","2022-06-13","2020-01-13","2020-01-13","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-08-03","2020-04-09","2020-04-09","2021-06-14","2022-05-23","2022-08-03","2022-08-03","2022-05-03","2020-04-09","2020-08-03","2020-08-03","2020-08-03","2022-08-10","2022-08-10","2022-08-03"],"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":[["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00143988701","AMOXICILLIN","SUS 400\/5ML","200","Select","Select",""],["","50383004224","PREDNISOLONE","SOL 15MG\/5ML","32","Select","Select",""],["","00456074513","AERCHMBR","MIS FLOW-VU","1","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","72140003263","AQUAPHOR","OIN ","396","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":""}]}]}