{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTWON   E MONTGOMERY","gend":0,"add":"2003 SAINT DENIS AVE APT 1","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1972-11-10","age":"","mstatus":"","insh":"20057591*01","cliId":"","pno":"347\/371-1301","cno":"347\/371-1301","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":"OHCC","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":["R11.2","R10.13","F17.210","Z20.822","I82.4Z2","B35.3","R10.9","M79.604","B07.0","M79.671","M79.672","R60.0","M20.41","M20.42","Z98.890","Z72.0","T14.90XA","B35.1","L84.","I10.","Z86.718","K02.9","K01.1","R22.1","R49.0","J43.9","H92.09","J02.9","R22.0","R51.9","M54.2","R51.","Z79.01","D23.72","K08.89","F10.120","R41.82","NO DATA","M79.89","M79.605","R79.9","B36.0","L85.3","Z71.9"],"date":["2021-09-13","2021-09-13","2022-08-27","2021-09-25","2020-08-02","2020-08-02","2020-08-02","2020-09-23","2020-11-10","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2021-09-13","2020-02-15","2020-08-20","2020-08-20","2020-08-20","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2022-08-27","2020-07-15","2020-07-15","2020-07-15","2020-09-10","2022-08-27","2021-09-29","2021-09-29","2020-06-09","2020-06-09","2020-06-09","2020-08-02","2020-11-25","2020-11-25","2020-11-25"],"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":[["","63304069205","CLINDAMYCIN","CAP 150MG","90","Select","Select",""],["","16477034001","UREA","CRE 0.4","85","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","00003376474","ELIQUIS","TAB 5MG","74","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","21","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":[]}},{"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":""}]}]}