{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH   Y SINGLETON","gend":1,"add":"629 DORENE PL APT 201","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1967-12-24","age":"","mstatus":"","insh":"20041419*01","cliId":"","pno":"757\/768-5073","cno":"757\/768-5073","email":"","ename":"","eno":"","pphy":"NEGAARD, KRISTIN D MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","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":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","J06.9","B97.89","R05.","F25.1","F41.9","F43.12","T38.0X5A","I10.","E11.42","K21.9","E66.01","J45.909","F32.9","E78.2","I25.10","G40.909","Z79.4","Z87.440","Z79.51","Z79.899","Z88.6","Z88.4","E11.3311","H92.02","J31.2","L03.114","R73.09","R73.9","E11.9","Z96.41","E11.69","E11.59","E78.5","J22.","J45.20","B02.9","Z68.37","R06.02","S50.362A","M25.522","M25.422","M25.512","L02.414","Z12.31","H43.813","H04.123","E11.3313","R01.1","I34.0","I51.7","R30.0","M79.2","E78.00","L02.11","R60.0","E11.3312","I51.89","G62.9","R10.11","R06.2","R56.9","J20.9","Z20.828","R07.82","R39.9","M25.551","L02.512","M25.562","R03.0","R09.89","R07.0","G60.3","H10.45","E66.9"],"date":["2021-07-20","2020-01-14","2020-01-04","2020-09-29","2021-07-01","2021-07-01","2021-07-01","2020-02-07","2021-05-25","2021-07-20","2021-06-22","2020-12-22","2020-08-24","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2021-05-25","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2021-07-27","2020-09-29","2020-09-29","2021-06-16","2020-02-06","2021-04-21","2020-02-07","2020-12-22","2021-05-25","2021-05-25","2021-05-25","2020-11-10","2020-11-04","2020-11-10","2020-12-22","2020-01-04","2020-12-02","2020-12-03","2020-12-03","2020-12-03","2021-06-16","2020-12-03","2021-02-09","2021-07-27","2021-07-27","2021-04-20","2021-04-20","2021-04-20","2021-04-21","2021-05-25","2020-03-20","2020-07-28","2020-12-01","2021-07-27","2021-04-20","2021-04-21","2021-04-21","2020-01-14","2020-02-04","2020-02-06","2020-10-29","2020-11-10","2020-01-14","2020-02-10","2020-12-04","2021-06-09","2021-06-09","2021-06-22","2021-06-22","2021-04-15","2021-07-27","2020-10-29"],"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":[]},{"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":""}]}]}