{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YRAHCAZSBBIG J ","gend":0,"add":"HMA 7116EVA TSRE","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1999-01-11","age":"","mstatus":"","insh":"3230210*28","cliId":"","pno":"96\/7572559-6","cno":"757\/696-9552","email":"","ename":"","eno":"","pphy":"WILLIAMS, MICHAEL MD","ppno":"757\/983-8600","pcpadd":"#200 114 N MAIN ST","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Downtown Suffolk","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":["E66.01","Z68.43","K30.","K76.0","K90.9","Z98.84","R74.0","K35.80","NO DATA","R09.82","R05.","K21.9","Z68.42","R07.9","I47.1","I25.10","I12.9","N18.2","F43.20","K80.20","R94.5","I11.0","I50.9","H81.12"],"date":["2021-07-07","2020-07-30","2020-07-30","2020-07-30","2020-12-10","2020-12-10","2020-01-24","2021-07-07","2021-07-07","2020-05-01","2020-05-01","2021-07-07","2021-07-07","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2020-04-05","2021-07-07","2020-07-30","2020-07-30","2020-07-30","2020-08-24"],"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":[["","00406012305","HYDROCO\/APAP","TAB 5-325MG","25","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","5","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","10","Select","Select",""],["","68462047401","URSODIOL","TAB 500MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00955100410","ENOXAPARIN","INJ 40\/0.4ML","11","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","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":""}]}]}