{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA   D AVANT-WILLIAMS","gend":1,"add":"3661 RIVERSIDE DR","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1957-08-06","age":"","mstatus":"","insh":"20068736*01","cliId":"","pno":"757\/819-3635","cno":"","email":"","ename":"","eno":"","pphy":"MISTRY, ZARINE MD","ppno":"757\/261-5910","pcpadd":"850 KEMPSVILLE RD SUITE 200A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Kempsville","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/466-1611","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.911","Z76.0","Z72.0","C50.111","Z17.0","E11.65","E66.3","Z79.4","E08.42","B34.9","Z20.822","R41.82","G93.41","E11.9","I10.","E78.5","M85.80","F17.210","K08.89","Z90.11","Z92.21","Z80.0","Z80.1","Z83.3","Z82.49","Z79.899","Z51.11","Z20.828","C50.919","E11.42","C50.211","N30.00","R41.0","N39.0","E11.40","E11.69","J44.9","B35.1","R53.81","Z85.3","E11.641","E11.59","Z12.11","I15.2","E11.8","J43.9","R53.83","Z86.79","Z01.812","F17.200","J06.9","D05.11","K57.30","K64.4","K64.8"],"date":["2021-09-07","2020-12-24","2021-05-26","2021-12-30","2021-12-30","2021-09-07","2021-05-12","2021-12-21","2021-05-12","2021-01-24","2021-04-30","2021-01-27","2021-01-25","2021-01-27","2021-05-26","2021-12-07","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2020-12-01","2021-11-26","2021-09-22","2021-12-07","2021-02-03","2021-01-25","2021-01-25","2021-01-27","2021-05-26","2021-12-07","2021-05-26","2021-05-26","2021-01-24","2021-12-07","2021-11-10","2021-12-07","2021-12-07","2021-12-07","2021-12-21","2021-03-16","2021-03-16","2021-01-25","2021-04-30","2021-09-07","2021-11-26","2020-10-09","2021-05-03","2021-05-03","2021-05-03"],"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":[["","70010010810","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","00002773701","INSULIN","INJ 100\/ML","20","Select","Select",""],["","","LISINOPRIL","TAB 40MG","","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","6","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","16729003415","LETROZOLE","TAB 2.5MG","90","Select","Select",""],["","00187540008","JUBLIA","SOL 0.1","8","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","57664037713","TRAMADOL","TAB 50MG","7","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","08627001601","DEXCOM","MIS TRANSMIT","1","Select","Select",""],["","72205001290","PREGABALIN","CAP 50MG","180","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","00093720110","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","AMITRIPTYLIN","TAB 100MG","","Select","Select",""],["","16714049401","AMOX\/K","TAB 500-125","21","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","6","Select","Select",""],["","","ONDANSETRON","TAB 8MG","","Select","Select",""],["","","FLUBLOK","INJ 2020-21","","Select","Select",""],["","","PROCHLORPER","TAB 10MG","","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":{"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":""}]}]}