{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HERBERT BROWN JR","gend":0,"add":"137 PINE ST","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1959-09-25","age":"","mstatus":"","insh":"20041890*01","cliId":"","pno":"757\/282-8630","cno":"757\/282-8630","email":"","ename":"","eno":"","pphy":"WILLIAMS, MICHAEL MD","ppno":"757\/983-8600","pcpadd":"#200 114 N MAIN ST","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":176457,"pcpname":"SMG - Sentara Internal Medicine Physicians - Downtown Suffolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/949-1748","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-1660","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I73.9","I65.23","R58.","F10.929","S00.83XA","I10.","S09.90XA","E86.0","I95.1","R11.0","R52.","Y04.8XXA","K21.0","J45.20","M54.40","G89.29","S93.124A","M20.11","M20.12","M20.21","M20.41","M20.42","I70.90","M79.671","Y09.","T74.11XA","I70.223","N40.1","R79.9","N13.8","I77.9"],"date":["2020-10-16","2020-10-16","2021-01-11","2021-01-11","2021-05-27","2021-05-27","2021-05-27","2020-07-16","2020-07-16","2020-07-16","2021-05-27","2021-05-27","2020-07-13","2020-01-09","2020-01-09","2020-01-09","2020-08-19","2020-08-19","2020-07-09","2020-07-09","2020-08-19","2020-07-09","2020-08-19","2020-07-09","2021-05-27","2021-05-27","2020-07-21","2020-07-13","2020-07-13","2020-07-13","2020-10-09"],"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":[["","68382041201","OMEPRAZOLE ","20MG","30","Select","Select",""],["","69097084607","CYCLOBENZAPR ","10MG","45","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180098001","LISINOPRIL ","10MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","68180098001","LISINOPRIL","10MG","30","Select","Select",""],["","68382041201","OMEPRAZOLE","20MG","30","Select","Select",""],["","69097084607","CYCLOBENZAPR","10MG","45","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","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","",""],["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":""}]}]}