{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   YCARTSNOMMIS ","gend":0,"add":"XOB OP3421 ","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1966-09-01","age":"","mstatus":"","insh":"29500210*04","cliId":"","pno":"57\/7575064-5","cno":"757\/755-4605","email":"","ename":"","eno":"","pphy":"BELVIN, DAVID G MD","ppno":"757\/542-2000","pcpadd":"SUITE 200 20209 SENTARA WAY","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Gloucester","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":["G89.29","M54.5","M54.16","M54.2","F41.9","Z79.891","Z51.81","R26.81","F17.210","Z00.00","I10.","M85.88","G89.4","F32.9","M48.02","E78.2","Z12.11","M47.12"],"date":["2020-05-26","2020-05-26","2021-08-03","2020-05-26","2020-02-25","2020-05-26","2021-08-03","2020-05-26","2020-05-26","2021-04-06","2021-04-06","2021-04-06","2021-08-03","2021-08-03","2021-08-03","2020-04-22","2020-04-22","2020-04-28"],"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":[["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","50228017805","GABAPENTIN","TAB 800MG","270","Select","Select",""],["","00093078701","ATENOLOL","TAB 25MG","90","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","180","Select","Select",""],["","68645055454","LISINOPRIL","TAB 30MG","30","Select","Select",""],["","31722059690","FENOFIBRATE","TAB 145MG","30","Select","Select",""],["","59385002260","BELBUCA","MIS 150MCG","30","Select","Select",""],["","70710111308","TIZANIDINE","CAP 6MG","90","Select","Select",""],["","16714068403","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","90","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":""}]}]}