{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRENT  N LUCAS","gend":0,"add":"23 DEAN RAY CT LOT N6","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1995-06-05","age":"","mstatus":"","insh":"20031339*01","cliId":"","pno":"757\/928-0925","cno":"757\/928-0925","email":"","ename":"","eno":"","pphy":"FRANCIS, ALBERT H MD","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DRIVE","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":149598,"pcpname":"SMG - Sentara Family Medicine Physicians - Peninsula Towne","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/827-9978","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.0","F90.2","F41.1","M54.9","V87.7XXA","G40.909","F17.200","Z13.9","S05.02XA","Z20.828","R69.","T14.90XA","I10.","G40.919","F41.9","F90.9","R63.4","E66.01","R62.50","Z13.220","S32.401A","J02.9","R11.2","R19.7"],"date":["2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-24","2021-03-24","2020-03-23","2020-03-23","2020-03-23","2020-05-15","2021-02-05","2021-03-24","2021-03-24","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2020-10-15","2021-06-08","2021-01-14","2021-01-14","2020-02-23","2020-08-26","2021-06-08","2021-06-08"],"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":[["","65862031560","LEVETIRACETA ","1000MG","60","Select","Select",""],["","62037083101","METOPROL ","50MG ER","30","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","60","Select","Select",""],["","00781713593","MOXIFLOXACIN ","HCL 0.5%","3","Select","Select",""],["","65862001105","SERTRALINE ","25MG","30","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","30","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","20","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":""}]}]}