{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ANITSIRHCDNALLOH R ","gend":1,"add":"SSAC 003EVA YDA","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1982-05-19","age":"","mstatus":"","insh":"9508710*58","cliId":"","pno":"19\/7572362-8","cno":"757\/469-7463","email":"","ename":"","eno":"","pphy":"PALTING, JOHN KENNETH MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","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":["F11.20","R94.31","I44.0","L02.01","H01.001","H16.223","F43.12","F33.3","F41.0","F90.9","R00.0","R06.02","F43.21","F41.1","F90.2","F32.9","F43.10","F41.9","Z51.81","G47.00","F33.0","R51.9","R42.","H61.21","NO DATA","H66.91"],"date":["2021-12-20","2020-02-22","2020-01-13","2021-02-15","2021-03-15","2021-03-15","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2020-02-22","2020-04-05","2020-12-22","2021-04-09","2020-12-22","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-06-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21"],"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":[["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","90","Select","Select",""],["","","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","00065065205","TOBRADEX","SUS 0.3-0.05","5","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","70954002010","PRAZOSIN","CAP 2MG","180","Select","Select",""],["","70954021210","TRIHEXYPHEN","TAB 2MG","14","Select","Select",""],["","68382011214","RISPERIDONE","TAB 0.25MG","60","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","90","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","180","Select","Select",""],["","51991000633","DESVENLAFAX","TAB 25MG ER","30","Select","Select",""],["","68462030205","INDOMETHACIN","CAP 50MG","20","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","90","Select","Select",""],["","","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","","MECLIZINE","TAB 25MG","","Select","Select",""],["","","HYDROXYZ","CAP 50MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","ERYTHROMYCIN","OIN 5MG\/GM","","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":""}]}]}