{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN CLARK","gend":0,"add":"201 LITTLE CREEK ROAD","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1977-11-04","age":"","mstatus":"","insh":"2242291*01","cliId":"","pno":"757\/319-3456","cno":"757\/319-3456","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","F14.20","F29.","F17.210","K21.9","Z91.5","Z59.0","E16.2","R51.","R68.84","R53.83","F51.09","F17.200","F32.9","F41.1","F32.2","F20.0","E11.9","T07.XXXA","F15.90","F33.3","V62.84","R44.0","F23.","G47.00","V58.89","F10.10","F15.10","F14.10","R44.1","Z11.59","R41.82","F10.239","D72.829","K08.89","Z91.14","M25.571","F19.10"],"date":["2020-07-21","2020-08-31","2020-01-09","2020-08-31","2020-08-31","2020-08-31","2020-01-09","2020-08-31","2020-01-13","2020-01-09","2020-06-28","2020-01-10","2020-01-10","2020-07-07","2020-07-07","2020-09-11","2020-09-04","2020-09-01","2020-06-28","2020-03-04","2020-04-15","2020-08-31","2020-06-26","2020-06-27","2020-06-27","2020-06-27","2020-07-21","2020-07-21","2020-08-05","2020-06-26","2020-06-26","2020-06-27","2020-07-18","2020-07-18","2020-08-31","2020-08-31","2020-07-20","2020-07-20"],"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":[["","43547034150","RISPERIDONE","TAB 1MG","28","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","14","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","14","Select","Select",""],["","00536137223","NICOTINE","GUM 4MG MINT","100","Select","Select",""],["","00185061505","HYDROXYZ","CAP 50MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","42","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":""}]}]}