{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERNESTINE   D LAWRENCE","gend":1,"add":"75 WELLESLEY DR APT 110","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1957-05-05","age":"","mstatus":"","insh":"20049159*01","cliId":"","pno":"757\/975-1034","cno":"","email":"","ename":"","eno":"","pphy":"FRANCIS, ALBERT H MD","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DRIVE","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Peninsula Towne","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/827-9978","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","E03.8","Z76.89","E06.3","T14.90XA","R69.","V58.89","R20.0","Z71.3","Z71.82","M62.81","M25.511","M54.41","Z87.828","M75.111","M75.41","R10.30","M79.609","T14.8XXA","Z74.09","V89.2XXD","E66.9","Z78.9","R15.1","R42.","R06.02","R07.9","E03.9","M51.36","G56.01","N89.8","M79.601","M25.521","Z12.39","E55.9","H53.8","R51.9","M75.101","M19.011","Z12.31","G89.29","R10.32","I51.89","K21.9","K44.9","K63.5","F41.9","F32.9","Z00.00","M54.2","Z12.4","Z13.220","Z12.12","R15.9","E53.8","V89.2XXA","M54.5","R63.5","T16.1XXA","Z23."],"date":["2021-03-05","2021-12-13","2021-12-13","2021-12-13","2021-10-07","2021-10-07","2021-12-28","2021-10-26","2021-12-13","2021-12-13","2021-12-07","2021-12-27","2021-12-27","2021-11-01","2020-10-21","2020-10-21","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2020-10-14","2020-10-29","2020-11-23","2020-11-23","2021-05-27","2021-07-01","2020-02-13","2020-02-13","2021-05-27","2020-08-19","2021-05-27","2021-08-19","2021-05-27","2021-05-27","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-11-30","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2019-01-09","2019-01-09","2019-01-09","2019-07-08","2019-11-24","2019-11-15"],"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":[["","55111018010","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","00527328846","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","40985027416","D3","CAP 2000UNIT","30","Select","Select",""],["","03504601130",""," ","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","30","Select","Select",""],["","46122043078","GNP","TAB 325MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","40","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":""}]}]}