{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERAINE   S BAILEY","gend":1,"add":"2429 CROMWELL ROAD","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1971-12-29","age":"","mstatus":"","insh":"20017855*01","cliId":"","pno":"757\/717-4892","cno":"757\/717-4892","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,"pcpcounty":"","pcpid":207883,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.411","Z17.1","E11.9","N39.41","C50.011","Z01.419","Z68.38"],"date":["2021-03-29","2021-03-29","2020-04-15","2020-02-03","2021-02-02","2020-08-14","2020-08-14"],"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":[["","65162017810","METFORMIN ","500MG ER","90","Select","Select",""],["","00591363630","TROSPIUM ","60MG ER","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","65162018910","NAPROXEN ","375MG","60","Select","Select",""],["","65162018910","NAPROXEN","375MG","60","Select","Select",""],["","65162017810","METFORMIN","500MG ER","90","Select","Select",""],["","00591363630","TROSPIUM","60MG ER","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","60","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","57237001830","DULOXETINE","30MG","30","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","30","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","",""],["No","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":""}]}]}