{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CONSTANCE R HARRIS","gend":1,"add":"3415 SOMME AVE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1968-10-18","age":"","mstatus":"","insh":"2299777*01","cliId":"","pno":"757\/776-1303","cno":"757\/776-1303, ","email":"","ename":"","eno":"","pphy":"MEBRAHTU, SEMRET T MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23517-9998","pcpcounty":"","pcpid":207883,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","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":["R25.2","M54.10","M79.603","J45.909","E78.5","I10.","Z79.899","M25.519","R73.03","R63.5","M54.2","Z12.11"],"date":["2020-05-16","2020-12-27","2020-12-27","2021-05-20","2021-05-20","2021-05-20","2020-12-27","2020-12-27","2021-05-20","2021-05-20","2020-05-18","2020-08-31"],"priorHcc":["","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","31722088290","ROSUVASTATIN","5MG","90","Select","Select",""],["","62332005090","LOSARTAN\/HCT","100-25","90","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","10135012310","ACETAMIN","325MG","20","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","180","Select","Select",""],["","00603389032","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","55111017915","TIZANIDINE","2MG","45","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","-20","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}