{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NIVRAMREPOOH","gend":0,"add":" WOBNIAR 253 RLRT TC","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1966-02-15","age":"","mstatus":"","insh":"39200210*98","cliId":"","pno":"49\/7579634-9","cno":"757\/949-4369","email":"","ename":"","eno":"","pphy":"FABIAN-GOTTLIEB, ARLENE P PA","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z52.008","R73.03","E78.2","R74.01","I10.","G47.33","E66.01","F32.1","E55.9","R73.09","Z12.5","Z00.00","Z12.11","F17.210","M54.41","Z71.6","G89.29","Z83.71","Z86.010","K64.8","K57.90","D12.0","D12.3","Z01.810","Z01.812","Z20.822","E66.9","M54.5","F41.9","Z51.81","K63.5","B35.3","Z71.89"],"date":["2021-05-17","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2022-11-23","2022-11-23","2021-04-07","2021-10-01","2021-03-05","2021-03-05","2021-04-07","2021-04-06","2021-10-01","2021-03-05","2021-10-01","2021-03-05","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-04-06","2021-04-06","2021-04-03","2021-04-03","2021-04-03","2021-11-23","2020-04-01","2020-04-01","2020-04-01","2021-04-06","2021-04-07","2021-04-07"],"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":[["","65162035109","SILDENAFIL","TAB 20MG","10","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","31722094201","HYDROCO\/APAP","TAB 7.5-325","6","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00067512614","NICOTINE","DIS 21MG\/24H","44","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","90","Select","Select",""],["","51672127501","CLOTRIMAZOLE","CRE 0.01","60","Select","Select",""],["","80681017401","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","70710111208","TIZANIDINE","CAP 4MG","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","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":""}]}]}