{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NADINE  M ROBERTS","gend":1,"add":"157 CANDLEWOOD WAY APT A","city":"NEWPORT NEWS","state":"VA","zip":23606,"dob":"1976-11-03","age":"","mstatus":"","insh":"1521343*01","cliId":"","pno":"757\/595-5018","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/594-1803","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","plan":"OHP","program":"Medicaid","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9223","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","N61.0","E11.9","I10.","F17.210","Z79.4","Z91.02","Z88.5","Z88.8","Z91.048","NO DATA","L03.319","L02.215","L02.219","K13.0","B18.2","B37.0","K61.1","F31.9","K21.9","Z81.1","Z82.62","Z83.3","B37.3","R73.9","T50.904A","R41.82","M54.42","M54.41","N64.4","Z09.","E11.65","F31.89","Z90.49","Z86.59","Z91.09","T40.1X1A","Z11.59","M54.5","Z20.828"],"date":["2022-11-06","2021-04-01","2021-11-14","2021-11-14","2021-11-14","2021-04-01","2021-11-14","2021-11-14","2021-11-14","2021-09-26","2021-04-01","2020-06-11","2020-06-15","2020-06-11","2020-06-11","2020-06-15","2020-06-11","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-11","2020-11-01","2020-11-01","2021-09-26","2021-09-26","2021-11-14","2020-06-15","2020-06-15","2021-11-14","2021-11-14","2021-11-14","2021-11-14","2020-11-01","2020-11-01","2021-09-26","2021-09-02"],"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":[["","","HUMALOG","INJ 100\/ML","","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","","BD  PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","","SM","DIS 21MG\/24H","","Select","Select",""],["","","GLUCOSE","CHW 4GM","","Select","Select",""],["","","INSULIN","INJ 100\/ML","","Select","Select",""],["","","LANCETS","MIS THIN","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}