{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONETTE   L BEAMON","gend":1,"add":"1000 THRIVE PL APT 100","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1974-01-23","age":"","mstatus":"","insh":"20023717*01","cliId":"","pno":"757\/641-9530","cno":"757\/641-9530","email":"","ename":"","eno":"","pphy":"FRANK, JANINE M MD","ppno":"757\/689-8430","pcpadd":"1925 GLENN MITCHELL DR STE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":141974,"pcpname":"Pembroke Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"434\/637-2162","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":["F31.32","F33.2","F20.9","F33.1","H92.03","H61.23","H93.293","F25.1","E55.9","F41.9","E78.5","Z71.2","F72.","J30.89","F81.0","R73.01","R79.89","Z01.419","B37.9","Z12.11","NO DATA","Z68.41","F51.05","F41.1","C50.211","Z17.0","H93.25"],"date":["2020-12-28","2021-07-07","2021-07-07","2021-04-14","2021-05-10","2021-05-10","2021-05-10","2021-09-09","2021-04-01","2021-07-07","2021-04-01","2021-03-03","2020-12-28","2021-07-07","2021-08-23","2021-02-02","2021-02-02","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-09-09","2021-09-09","2021-11-03","2021-11-03","2021-11-05"],"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":[["","00591024105","LORAZEPAM ","1MG","90","Select","Select",""],["","43068010602","FANAPT ","6MG","60","Select","Select",""],["","00008122230","PRISTIQ ","100MG","30","Select","Select",""],["","00054040113","DESVENLAFAX ","100MG ER","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00093077198","PRAVASTATIN ","10MG","30","Select","Select",""],["","31604002743","MELATONIN ","5MG","90","Select","Select",""],["","00316022115","NYSTATIN ","100000","15","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48","Select","Select",""],["","00008122230","PRISTIQ","100MG","30","Select","Select",""],["","43068010602","FANAPT","6MG","60","Select","Select",""],["","00591024105","LORAZEPAM","1MG","90","Select","Select",""],["","00054040113","DESVENLAFAX","100MG ER","30","Select","Select",""],["","00093077198","PRAVASTATIN","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00316022115","NYSTATIN","100000","15","Select","Select",""],["","31604002743","MELATONIN","5MG","90","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","",""],["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":""}]}]}