{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMUEL   W WING","gend":0,"add":"104 OSLO CT","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1989-05-25","age":"","mstatus":"","insh":"20054121*01","cliId":"","pno":"757\/903-7195","cno":"757\/903-7195","email":"","ename":"","eno":"","pphy":"JAVERNICK, MICHAEL J MD","ppno":"757\/345-4600","pcpadd":"STE 450 400 SENTARA CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-4601","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F90.2","G43.011","M70.21","M62.830","J10.1","R68.89","M25.561","Z23.","S83.241A","S00.03XA","G89.29","S83.221A","W18.49XA","Y92.481","M17.11","V58.89","Z00.00","E03.4","E66.01","G43.009","F31.70","B07.8","Z59.7"],"date":["2022-05-17","2022-05-17","2022-01-14","2022-01-14","2022-01-14","2020-03-09","2020-03-09","2022-05-03","2021-10-12","2022-05-27","2021-06-17","2021-11-16","2022-05-03","2022-05-03","2022-05-03","2022-05-27","2021-12-06","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2022-07-12","2022-05-17"],"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":[["","65862018730","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","68382080610","TRAZODONE","TAB 100MG","90","Select","Select",""],["","69238184001","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","29300011416","LAMOTRIGINE","TAB 200MG","60","Select","Select",""],["","67877024710","QUETIAPINE","TAB 300MG","90","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","10","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","60","Select","Select",""],["","10702018950","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00078043305","FOCALIN","CAP 30MG","30","Select","Select",""],["","65757065242","LYBALVI","TAB 10-10MG","30","Select","Select",""],["","31722023401","DEXMETHYLPH","CAP 30MG ER","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","42806001101","SULINDAC","TAB 200MG","20","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","100","Select","Select",""],["","68382024701","BENZONATATE","CAP 100MG","30","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","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":""}]}]}