{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN  G THOMAS","gend":0,"add":"924 MAXIMUS SQ APT 203","city":"VIRGINIA BEACH","state":"VA","zip":23451,"dob":"1958-09-18","age":"","mstatus":"","insh":"20041451*01","cliId":"","pno":"757\/779-8428","cno":"","email":"","ename":"","eno":"","pphy":"Mebrahtu, Semret","ppno":"757\/395-6900","pcpadd":"984 B Laskin Road ","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/425-7180","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","F20.3","F10.20","F12.20","F60.9","E11.65","E78.5","I10.","E03.9","F20.0","E78.2","R97.20","Z68.39","F43.10","F41.0","H92.01","H60.90","E66.01"],"date":["2021-02-18","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-10-07","2021-09-17","2021-09-17","2021-09-17","2020-04-07","2021-02-18","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2021-02-18"],"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":[["","55111032201","GLIMEPIRIDE","TAB 4MG","180","Select","Select",""],["","68180035205","SERTRALINE","TAB 50MG","28","Select","Select",""],["","68180096501","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","28","Select","Select",""],["","65162075750","DIVALPROEX","TAB 500MG ER","84","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","300","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00006057761","JANUMET","TAB 50-1000","180","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","11822316910","RA","TAB 81MG EC","90","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","200","Select","Select",""],["","00193654621","BAYER","MIS LANCETS","200","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","3","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","08290328203","BD  PEN NEEDL","MIS 29GX12.7","100","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}