{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTOINE DANCY","gend":0,"add":"7206 NEWPORT AVE APT 26","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1986-12-16","age":"","mstatus":"","insh":"1655171*01","cliId":"","pno":"757\/956-8937","cno":"757\/956-8937","email":"","ename":"","eno":"","pphy":"WARE, JENNIFER L MD","ppno":"757\/388-9925","pcpadd":"7401 GRANBY ST","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/965-8519","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N17.9","R06.02","D64.9","H35.00","H53.419","K21.9","J45.40","D59.9","R10.84","H53.412","R51.","D72.819","D59.5","D70.9","Z20.828","R50.81","R13.10","Z51.12","K64.8","D53.9","E80.6","R11.10","U07.1","J12.89","D61.818","Q93.9","E83.39","E86.9","D46.9","R91.8","T50.8X5A","N14.1","N18.9","R59.0","D50.9","R93.89","I10.","Z23.","E87.2","D69.6","E87.6","J02.9","J45.20","R31.9","R39.12","K64.9","E66.09","Z68.37","K29.70","D59.8","D62.","R50.9","E80.20","K92.1","N19.","R42.","R10.9","A41.9","N39.0","R00.0","D89.9","Z09.","R10.13","R53.83","R63.0","K25.9","K59.00","E86.0","M54.5","R11.0","E83.01"],"date":["2020-08-31","2020-05-07","2022-10-17","2020-05-11","2020-07-20","2020-08-03","2020-08-03","2020-05-11","2020-05-11","2020-05-14","2020-08-06","2020-05-23","2022-10-24","2020-08-14","2021-09-18","2020-08-14","2021-08-17","2022-10-24","2022-10-10","2020-05-04","2022-05-03","2020-07-20","2020-08-31","2020-08-24","2020-08-12","2020-08-03","2020-08-14","2020-08-03","2020-08-12","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2022-10-17","2020-08-03","2020-08-14","2020-08-26","2020-07-07","2020-08-13","2020-08-13","2020-08-23","2021-09-18","2022-10-17","2022-06-20","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2020-05-01","2020-05-05","2020-05-05","2020-08-06","2020-05-09","2021-08-02","2020-08-07","2021-09-14","2020-05-04","2020-08-03","2020-05-06","2020-05-04","2020-08-03","2020-08-31","2020-05-03","2020-05-03","2020-05-03","2020-05-04","2020-05-04","2020-05-04","2020-05-04","2020-05-04","2020-05-04"],"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":[]},{"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":[["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","60","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","16714047801","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","12843003520","STOOL","CAP 100MG","30","Select","Select",""],["","49348014370","SM","POW ","238","Select","Select",""],["","57896070310","IRON","TAB 325MG","28","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","49035031207","EQ","POW ","238","Select","Select",""],["","70000041502","CLEARLAX","POW ","238","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","00536124701","SENEXON-S","TAB 8.6-50MG","60","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","4","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","60","Select","Select",""],["","00904052380","VITAMIN","TAB 500MG","28","Select","Select",""],["","49348081705","ACID","TAB 20MG","30","Select","Select",""],["","63739064510","FAMOTIDINE","TAB 20MG","30","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":""}]}]}