{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GREGORY   D WALLACE","gend":0,"add":"PO BOX 6753","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1981-03-07","age":"","mstatus":"","insh":"2203438*01","cliId":"","pno":"757\/949-5772","cno":"757\/949-5772","email":"","ename":"","eno":"","pphy":"MANSELL, MARSHA P NP","ppno":"757\/983-5100","pcpadd":"4124 CHESAPEAKE SQ BLVD STE 103","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Chesapeake Square","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/673-8292","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I51.7","J96.00","J80.","J96.01","R91.8","F12.90","F14.90","F11.90","E87.6","F32.2","Z98.890","M51.26","M54.41","G89.29","I10.","K21.9","R40.2210","T40.1X4A","R04.89","R04.2","T50.901A","Z00.01","S40.021A","S90.02XA","R09.02","V89.2XXA","Z13.220","Z12.5","Z13.1","F17.290","Z88.6","M79.621","T50.911A","J18.9","E87.2","F12.10","F14.10","F17.200","Z03.818","Z79.899","I82.409","B95.62","E87.8","M54.5","M54.16","Z72.0","Z87.09","S16.1XXA","M79.604","V49.50XA","Y93.89","Y92.411"],"date":["2020-04-30","2020-04-30","2020-05-04","2020-05-05","2020-05-04","2020-05-04","2020-05-04","2020-05-04","2020-05-04","2022-10-25","2022-09-01","2022-09-01","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2020-04-30","2020-04-30","2020-05-03","2020-05-03","2020-05-03","2021-01-07","2022-06-19","2022-06-19","2021-08-10","2021-08-10","2022-05-16","2022-05-16","2022-05-16","2022-06-19","2022-06-19","2022-06-19","2020-04-30","2020-04-30","2020-05-01","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-05-01","2020-05-01","2020-05-01","2021-08-10","2020-02-13","2020-02-13","2020-05-13","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10"],"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":[]},{"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":[["","55111015810","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","68382097001","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","68180031902","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","30","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","30","Select","Select",""],["","65862047099","LOSARTAN\/HCT","TAB 100-25","90","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","00093414856","LEVALBUTEROL","NEB 1.25MG","180","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","2","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","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":""}]}]}