{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLIE   L ADMETTRE","gend":1,"add":"5472 GREENPLAIN RD APT 205","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1985-10-03","age":"","mstatus":"","insh":"1722081*01","cliId":"","pno":"470\/318-9444","cno":"470\/318-9444","email":"","ename":"","eno":"","pphy":"MEBRAHTU, SEMRET T MD","ppno":"757\/395-6900","pcpadd":"184B LASKIN RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":117346,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/425-7180","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.1","F41.1","F90.0","Z63.4","G47.33","Z82.0","E55.9","E66.3","K08.89","Z68.28","Z20.828","A08.4","Z86.39","T75.3XXA","Z30.09","Z11.3","Z30.430","Z32.02","Z00.00","E11.9","E78.5","G47.30","Z13.21","J30.9","R05.","G47.00","Z79.84","Z79.899","Z88.8","R53.83","F34.1","R09.82","J37.0","K21.9","J30.1","R06.83","R06.81","R40.0","Z72.821","G47.8","R79.0","L84."],"date":["2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-05-08","2020-03-11","2020-03-11","2020-01-23","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-03-17","2020-06-29","2020-06-09","2020-03-17","2020-03-17","2020-06-09","2020-06-09","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-07-27","2020-05-25","2020-06-29","2020-07-27","2020-06-29","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-06-29"],"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":[["","45802058084","SCOPOLAMINE ","1MG\/3DAY","4","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","00067434604","TRANSDERM ","1MG\/3DAY","4","Select","Select",""],["","66758020854","TRANSDERM-SC ","1.5MG","4","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","2","Select","Select",""],["","24208034425","FLUNISOLIDE ","0.03%","25","Select","Select",""],["","59310003825","NASALIDE ","0.03%","25","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","90","Select","Select",""],["","00555097202","AMPHET\/DEXTR ","10MG","90","Select","Select",""],["","00363011208","WAL-PHED ","30MG","28","Select","Select",""],["","65862020199","LOSARTAN ","25MG","45","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","8","Select","Select",""],["","68180051202","LISINOPRIL ","2.5MG","30","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100","Select","Select",""],["","00904505324","SUDOGEST ","30MG","28","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","30","Select","Select",""],["","66758020854","TRANSDERM-SC","1.5MG","4","Select","Select",""],["","45802058084","SCOPOLAMINE","1MG\/3DAY","4","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","00067434604","TRANSDERM","1MG\/3DAY","4","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","2","Select","Select",""],["","31722070010","LOSARTAN","25MG","30","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","6","Select","Select",""],["","68180051202","LISINOPRIL","2.5MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","24208034425","FLUNISOLIDE","0.03%","25","Select","Select",""],["","00904505324","SUDOGEST","30MG","28","Select","Select",""],["","59310003825","NASALIDE","0.03%","25","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","100","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","90","Select","Select",""],["","00555097202","AMPHET\/DEXTR","10MG","90","Select","Select",""],["","00363011208","WAL-PHED","30MG","28","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","00363017508","PAIN ","TAB 500MG","21","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","21","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}