{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SCOTT WOODFIN","gend":0,"add":"707 HAMPSHIRE PL","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1968-06-07","age":"","mstatus":"","insh":"20060211*01","cliId":"","pno":"757\/402-3363","cno":"757\/402-3363","email":"","ename":"","eno":"","pphy":"KIMES, CAROLYN M NP","ppno":"757\/363-6800","pcpadd":"816 INDEPENDENCE BLVD STE 100","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9023","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F30.2","F25.1","F14.20","F10.20","L72.9","L08.9","F31.30","B18.2","Z12.11","F33.3","F25.9","F17.200","B19.20","G56.22","R20.2"],"date":["2021-06-02","2022-04-14","2022-04-14","2022-04-14","2021-08-25","2021-08-25","2020-05-23","2020-06-25","2020-06-25","2020-04-14","2020-04-17","2021-06-30","2020-01-06","2020-08-06","2020-08-06"],"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":[["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","43547034450","RISPERIDONE","TAB 4MG","60","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","43598044774","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","68462012705","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00378032701","HALOPERIDOL","TAB 5MG","30","Select","Select",""],["","68220013301","COLYTE\/FLAVR","SOL PACKS","3785","Select","Select",""],["","43386006019","GAVILYTE-C","SOL ","4000","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","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":""}]}]}