{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TASHI   A PRIOLEAU","gend":1,"add":"142 DOOLITTLE RD APT 28","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1990-06-09","age":"","mstatus":"","insh":"2249146*01","cliId":"","pno":"703\/678-1854","cno":"","email":"","ename":"","eno":"","pphy":"GLAVE, KRISTLE M NP","ppno":"757\/736-3700","pcpadd":"2104 EXECUTIVE DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Peninsula Towne","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/827-9978","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","Z82.0","Z82.49","Z79.4","R10.84","E11.65","N30.00","R64.","E44.0","R00.0","R63.4","E10.10","Z68.1","F41.1","F32.9","E87.6","E86.0","G47.00","Z83.3","Z91.19","Z79.899","Z91.040","Z28.21","R51.9","N92.0","E11.8","F41.9","F32.0","R41.82","E10.65","R10.2","R39.89","R30.9","R11.0","R11.2","R10.9","R03.0","R63.0","F43.9","G47.9","K58.2","L02.91","Z20.822","Z91.041","Z09.","Z20.2","K59.00","Z87.59","R19.12","N39.0","R79.89","Z01.419","N89.8","R53.81","Z11.3","Z11.4","N76.0","R35.0","Z63.79","E08.10","Z86.39","R53.83","Z76.89","Z13.220","N76.2","E11.9"],"date":["2021-11-23","2021-11-21","2021-11-21","2021-11-21","2021-10-13","2021-11-21","2020-08-27","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-21","2021-11-21","2021-11-21","2021-02-04","2021-02-01","2021-11-21","2021-02-01","2021-11-21","2021-09-03","2021-11-21","2021-10-13","2021-02-01","2021-02-01","2021-02-01","2021-09-30","2021-09-30","2021-09-30","2020-06-16","2021-11-23","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-11-21","2021-10-13","2021-10-13","2020-09-11","2021-09-03","2021-09-03","2020-09-11","2021-09-03","2021-11-21","2021-11-21","2020-07-01","2020-07-01","2020-07-01","2021-02-04","2021-10-13","2021-10-13","2021-10-13","2020-01-06","2020-01-06","2021-11-21","2019-07-18","2019-11-25","2019-07-18","2019-03-22","2019-03-22","2019-03-22","2019-11-25","2019-11-25","2019-11-25","2019-11-25","2019-09-02","2019-09-02"],"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":[["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","66733082259","INSULIN","INJ 100\/ML","15","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","10","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","300","Select","Select",""],["","70710122701","AMITRIPTYLIN","TAB 50MG","90","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","65862002106","MIRTAZAPINE","TAB 15MG ODT","30","Select","Select",""],["","38396061375","CVS","CHW FRUIT","100","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","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":""}]}]}