{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA   L WILLIAMS","gend":1,"add":"1008 ALCON CT","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1985-02-10","age":"","mstatus":"","insh":"1177414*01","cliId":"","pno":"757\/635-4601","cno":"","email":"","ename":"","eno":"","pphy":"CHILDERS, ASHLEY PA-C","ppno":"757\/507-0305","pcpadd":"1950 GLENN MITCHELL DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-0306","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z30.431","L98.8","F17.219","K52.9","K62.5","R09.89","E03.8","E06.3","M25.531","J01.40","J40.","J06.9","F33.1","F41.1","F41.0","F90.0","Z00.00","R79.89","Z83.49","E78.2","Z20.822","G43.009","J45.21","H65.92","H92.02","K52.89","R19.7","K63.5","J02.9","Z01.812","Z30.433","Z30.430","J45.901","Z87.01","F17.200"],"date":["2019-06-11","2020-12-10","2019-06-11","2019-06-11","2019-10-27","2019-10-30","2020-03-13","2021-11-26","2021-11-26","2019-01-21","2019-09-16","2019-09-16","2019-09-20","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2019-07-05","2019-07-05","2019-11-27","2019-11-27","2019-11-27","2020-01-09","2019-04-25","2019-04-25","2019-04-25","2020-03-13","2020-03-13","2020-03-13"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","12","Select","Select",""],["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","52544008001","FIORICET","CAP ","12","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","43","Select","Select",""],["","","FLUTIC\/SALME","AER 100\/50","","Select","Select",""],["","","ADVAIR","AER 100\/50","","Select","Select",""]]}},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}