{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA SELBY-ROBINSON","gend":1,"add":"1204 LITTLE BAY AVE APT 1","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1978-12-27","age":"","mstatus":"","insh":"2177357*01","cliId":"","pno":7572980504,"cno":"","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":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/965-8519","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","R78.81","K13.0","L03.116","D48.5","B20.","M46.20","B18.2","D72.819","F17.200","B19.20","M46.26","Z11.3","Z13.220","H16.001","H16.231","Z86.19","R52.","M54.9","R60.0","Z21.","L08.9","A41.9","R69.","T14.90XA","Z87.898","R21.","F11.20","A41.02","E87.1","B02.30","D69.6","F11.10","F14.10","F17.210","NO DATA","R16.1","E87.6","M47.26","M54.41","L57.0","Z83.3","R65.10","M47.20","E87.2","K59.00","G89.29","B94.8","V58.69","Z91.128","Z88.1","M47.12","M40.12","M54.2","M25.569","S01.01XA","V89.2XXA","T07.XXXA","F91.9","F19.90","K04.7","K12.2","I38.","L82.1","B02.33"],"date":["2020-05-05","2020-05-06","2020-05-05","2020-05-05","2020-03-06","2020-10-23","2020-05-05","2020-05-05","2020-05-05","2020-05-14","2020-10-19","2020-05-14","2020-05-14","2020-05-14","2020-10-23","2020-10-16","2020-10-16","2020-03-02","2020-10-10","2020-03-05","2020-10-10","2020-04-19","2020-04-19","2020-08-17","2020-08-17","2020-03-12","2020-03-22","2020-10-10","2020-03-04","2020-03-04","2020-10-19","2020-10-10","2020-03-04","2020-03-04","2020-10-10","2020-03-04","2020-03-04","2020-10-10","2020-03-04","2020-03-04","2020-03-04","2020-10-10","2020-03-04","2020-03-12","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-04-01","2020-04-01","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-10-19","2020-10-19","2020-04-04","2020-04-04","2020-03-07","2020-03-12","2020-10-10"],"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":[["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","BANOPHEN","CAP 25MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","","METHADONE","TAB 10MG","","Select","Select",""],["","","QUETIAPINE","TAB 25MG","","Select","Select",""],["","","VITAMIN","TAB 1000MG","","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","LUBRICATING","DRO 0.005","","Select","Select",""],["","","REFRESH","DRO 0.5% OP","","Select","Select",""],["","","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","","BIKTARVY","TAB ","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","LUBRICNT","DRO 0.5% OP","","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","","SM","DIS 14MG\/24H","","Select","Select",""],["","","ZADITOR","DRO 0.025%OP","","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":""}]}]}