{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANNON   D HAWKINS","gend":1,"add":"7 GUENEVERE CT APT D","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1984-07-22","age":"","mstatus":"","insh":"2215233*01","cliId":"","pno":"757\/343-2019","cno":"757\/343-2019","email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":"757\/594-1850","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":119880,"pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/867-0215","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":["M25.562","M17.12","M22.42","J30.1","J30.2","J30.81","K21.9","R06.7","R09.82","R09.81","H10.13","J98.4","F17.200","R51.","G47.10","G47.33","G47.61","M48.07","M51.36","M47.816","G47.419","R06.2","R51.9","R40.0","J30.89","J45.20","S83.242A","S83.012A"],"date":["2020-10-09","2020-10-09","2020-10-09","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-07-14","2020-12-10","2020-07-14","2020-09-24","2020-08-04","2020-09-24","2020-03-17","2020-03-17","2020-03-17","2020-09-01","2020-12-10","2020-12-10","2020-12-10","2020-07-15","2020-12-23","2020-01-16","2020-01-16"],"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":[["","10702001801","OXYCODONE ","5MG","40","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","50228046601","NABUMETONE ","750MG","60","Select","Select",""],["","00378343293","ARMODAFINIL ","150MG","30","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","20","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","00067815203","VOLTAREN ","1%","100","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","11822046713","PAIN ","325MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","21","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","16714049401","AMOX\/K ","500-125","21","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","10702001801","OXYCODONE","5MG","40","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","50228046601","NABUMETONE","750MG","60","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","90","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","00378343293","ARMODAFINIL","150MG","30","Select","Select",""],["","42806031250","DOXYCYCL","100MG","20","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","65162046650","IBUPROFEN","800MG","21","Select","Select",""],["","11822046713","PAIN","325MG","30","Select","Select",""],["","16714049401","AMOX\/K","500-125","21","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","60","Select","Select",""],["","00067815203","VOLTAREN","1%","100","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65862090801","CELECOXIB ","CAP 100MG","60","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","",""],["N\/A","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":""}]}]}