{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACOB RIGGINS","gend":0,"add":"11 DUNCAN DR 11 DUNCAN DR","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1996-07-13","age":"","mstatus":"","insh":"20034021*01","cliId":"","pno":"757\/788-8700","cno":"757\/788-8700","email":"","ename":"","eno":"","pphy":"JOYNER, AERIAN K NP","ppno":"757\/827-2025","pcpadd":"STE 300 4001 COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":700501,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9802","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.9","F25.0","E03.2","E04.9","E04.2","Z76.89","Z71.3","Z71.82","R35.0","R51.9","N39.41","K62.5","K59.00","Z00.00","Z23.","G43.009","R74.01","E66.01","Z68.41","R74.8","R56.9","K76.0"],"date":["2021-10-18","2021-10-18","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-07-16","2020-11-11","2021-07-16","2021-03-01","2021-03-01","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-11-02","2020-11-02"],"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":[["","61874013030","VRAYLAR ","3MG","30","Select","Select",""],["","69238183607","LEVOTHYROXIN ","125MCG","90","Select","Select",""],["","16729013816","CLONAZEPAM ","2MG","60","Select","Select",""],["","00603243821","BENZTROPINE ","1MG","90","Select","Select",""],["","00115166001","PROPRANOLOL ","20MG","120","Select","Select",""],["","70954000520","OXYBUTYNIN ","5MG","90","Select","Select",""],["","00469260130","MYRBETRIQ ","25MG","30","Select","Select",""],["","50111043401","TRAZODONE ","100MG","45","Select","Select",""],["","00378623101","CITALOPRAM ","10MG","15","Select","Select",""],["","60505470203","SOLIFENACIN ","5MG","90","Select","Select",""],["","51248015001","VESICARE ","5MG","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","","20","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2","Select","Select",""],["","51862094105","DIAZEPAM ","2MG","1","Select","Select",""],["","00574041207","POLYETH ","3350 NF","30","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","40","Select","Select",""],["","11523726803","MIRALAX ","3350 NF","30","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0","Select","Select",""],["","50111043401","TRAZODONE","100MG","45","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","69238183607","LEVOTHYROXIN","125MCG","30","Select","Select",""],["","00603243821","BENZTROPINE","1MG","90","Select","Select",""],["","00115166001","PROPRANOLOL","20MG","120","Select","Select",""],["","00469260130","MYRBETRIQ","25MG","30","Select","Select",""],["","16729013816","CLONAZEPAM","2MG","60","Select","Select",""],["","70954000520","OXYBUTYNIN","5MG","90","Select","Select",""],["","00378623101","CITALOPRAM","10MG","15","Select","Select",""],["","51248015001","VESICARE","5MG","5","Select","Select",""],["","60505470203","SOLIFENACIN","5MG","90","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","","20","Select","Select",""],["","51862094105","DIAZEPAM","2MG","1","Select","Select",""],["","55111017915","TIZANIDINE","2MG","40","Select","Select",""],["","11523726803","MIRALAX","3350 NF","30","Select","Select",""],["","59676058005","JANSSEN","COVID-19","0","Select","Select",""],["","45802086866","POLYETH","3350 NF","30","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","72618300002","NURTEC ","TAB 75MG ODT","16","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":""}]}]}