{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AHSEENYKSTNACCM ","gend":1,"add":"OTS 2246HTAP YEN","city":"NORFOLK","state":"VA","zip":23502,"dob":"2002-06-27","age":"","mstatus":"","insh":"3315810*29","cliId":"","pno":"-5541988","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/955-2828","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Hospital Medicine Physicians - SVBGH","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B34.9","R42.","Z20.828","E11.65","Z48.02","S61.412A","Z11.3","E11.9","E66.8","J02.9","R68.89","Z30.42","Z03.818","Z01.411","N93.9","Z30.013","Z32.02","A56.00","A54.00","Z23.","Z11.59","Z13.0","Z13.220","Z13.89","E66.01","Z68.42","Z30.40","Z30.430","Z87.42","N92.0","D68.8","Z82.49","Z68.54","Z71.3","Z79.3","N94.6","R73.09","R73.9","S99.912A","N92.6","E86.0","R11.2","A60.04","N30.00","Z20.2","NO DATA","R50.9","R51.9","R10.9","Z20.822","Z01.419","A60.9","R19.7","E66.9","R05.9","R53.83","Z00.00","A60.09","Z79.84"],"date":["2020-12-07","2020-12-07","2020-12-07","2021-04-12","2021-06-07","2021-06-01","2021-10-19","2022-10-31","2020-05-13","2022-01-05","2020-12-02","2022-10-10","2020-07-19","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-11-22","2021-11-22","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2022-10-31","2022-10-31","2022-10-31","2019-01-02","2019-01-02","2019-01-02","2019-07-17","2019-07-17","2019-07-17","2022-01-05","2019-08-01","2019-06-13","2019-06-13","2019-07-18","2019-07-18","2019-01-26","2019-03-11","2019-03-14","2022-01-05","2022-04-09","2022-04-09","2022-04-09","2022-01-05","2022-01-05","2022-01-05","2022-01-02","2022-01-05","2022-02-07","2022-05-04","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-10-31","2022-10-31","2022-10-31"],"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":[["","68382076010","METFORMIN","TAB 1000MG","30","Select","Select",""],["","59779010112","PAIN","TAB 500MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","49483034150","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","66993037083","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","53885013610","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","14","Select","Select",""],["","68382079201","ACYCLOVIR","TAB 800MG","50","Select","Select",""],["","56151147002","TRUE","KIT METER","1","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","","LEVONORGESTR","TAB 1.5MG","","Select","Select",""],["","","VIENVA","TAB 0.1-20","","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","","FC2","MIS CONDOM","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","","MECLIZINE","CHW 25MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","00591215990","CICLOPIROX","SHA 0.01","120","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00555902658","JUNEL","TAB 44581","28","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","68462053253","CLOBETASOL","SOL 0.0005","100","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","08373747800","OPTICHAMBER","MIS DIAMOND","1","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}