{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHEALA   L HAWKINS","gend":1,"add":"9564 RICHMOND RD","city":"LANEXA","state":"VA","zip":"23089-9998","dob":"1965-03-13","age":"","mstatus":"","insh":"20028896*01","cliId":"","pno":"757\/645-6327","cno":"757\/645-6327","email":"","ename":"","eno":"","pphy":"JAVERNICK, MICHAEL J MD","ppno":"757\/345-4600","pcpadd":"STE 450 400 SENTARA CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":130627,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-4601","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","F41.1","N20.0","E11.9","R39.81","R10.30","R10.2","K52.9","R50.9","K04.99","Z00.00","E78.5","I10.","N39.3","E55.9","E89.40","M25.50","K42.9","J30.2","Z87.891","R07.9","R31.29","R73.9","G47.33","K43.0","Z72.0"],"date":["2021-11-23","2021-02-18","2020-01-30","2021-08-24","2021-08-24","2020-01-30","2020-01-30","2020-08-21","2020-08-21","2020-04-22","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-05-07","2021-03-10","2021-03-10","2020-04-16","2020-05-19","2020-05-19","2020-05-19","2021-09-14","2021-09-08"],"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":[["","51672413204","LAMOTRIGINE ","150MG","30","Select","Select",""],["","63402031230","LATUDA ","120MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","30","Select","Select",""],["","68180031902","BUPROPN ","150MG XL","90","Select","Select",""],["","00186038430","ESOMEPRA ","40MG DR","30","Select","Select",""],["","50111043402","TRAZODONE ","100MG","60","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","11","Select","Select",""],["","43547027010","ROPINIROLE ","1MG","60","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","30","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","61874013030","VRAYLAR ","3MG","30","Select","Select",""],["","27241019230","TOLTERODINE ","4MG ER","90","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","23155050101","HYDROXYZ ","25MG","90","Select","Select",""],["","50111043402","TRAZODONE","100MG","60","Select","Select",""],["","68180031902","BUPROPN","150MG XL","90","Select","Select",""],["","23155050101","HYDROXYZ","25MG","90","Select","Select",""],["","63402031230","LATUDA","120MG","30","Select","Select",""],["","51672413204","LAMOTRIGINE","150MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","11","Select","Select",""],["","68180051303","LISINOPRIL","5MG","11","Select","Select",""],["","00186038430","ESOMEPRA","40MG DR","30","Select","Select",""],["","43547027010","ROPINIROLE","1MG","60","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","30","Select","Select",""],["","61874011530","VRAYLAR","1.5MG","30","Select","Select",""],["","27241019230","TOLTERODINE","4MG ER","90","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","28","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","",""],["Yes","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":""}]}]}