{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAVONDA BRADLEY","gend":1,"add":"102 GOLDENGATE DR APT 102","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1987-09-03","age":"","mstatus":"","insh":"3673693*01","cliId":"","pno":"757\/602-3396","cno":"757\/602-3396","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":"","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":["M17.12","M76.52","J30.1","R09.81","R09.82","E66.9","J30.89","S83.011A","M22.41","S83.281A","I10.","K21.9","S83.221A","R07.89","M25.461","M22.8X1","M17.11","Z09.","F17.210","Z63.6","J45.909","M25.561","M89.9","G89.29","J06.9","M23.332","M22.42","Y93.A1","M25.562","H69.83","H92.01","R07.9","R73.03","F32.9","E66.01","Z68.41","Z01.419","Z11.3","A63.0","M75.42","J01.90","B97.89","B34.9","Z20.822","H92.02","J34.2","J34.3","J11.1","V58.89","J30.81","R26.9","Z79.899","L02.31","M54.5","J98.01","Z23.","R73.9","R87.612","R00.0","S83.242A"],"date":["2021-06-25","2020-05-29","2021-06-03","2021-06-03","2021-03-09","2020-08-19","2021-07-22","2020-10-08","2021-03-11","2020-10-08","2021-06-25","2021-06-25","2020-10-08","2020-02-09","2020-10-02","2020-10-02","2020-10-02","2020-02-10","2020-11-17","2020-11-17","2020-02-10","2020-08-14","2020-08-05","2020-08-05","2020-01-08","2020-04-24","2020-03-27","2020-03-27","2020-08-14","2020-05-27","2020-05-27","2020-06-19","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2021-02-05","2021-02-05","2021-02-25","2021-03-11","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-06-03","2021-06-03","2021-06-03","2020-02-04","2021-06-07","2020-07-09","2020-08-14","2020-08-14","2020-10-19","2020-01-14","2020-06-19","2020-11-05","2020-01-06","2020-01-06","2020-02-05","2021-06-18"],"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":[[["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":""}]}]}