{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAWANNA MORTON","gend":1,"add":"4050 VICTORIA BLVD APT 411","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1980-01-23","age":"","mstatus":"","insh":"9197443*01","cliId":"","pno":"757\/827-1528","cno":"757\/915-1263","email":"","ename":"","eno":"","pphy":"BOWERS, LEO MD","ppno":"757\/728-1100","pcpadd":"26 WINE ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Hospital Medicine Physicians - SCH","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/728-0870","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","B35.3","F31.9","K21.9","E78.5","L20.84","J30.9","M89.49","G56.00","F17.200","Z32.02","Z30.42","M20.11","M20.12","M21.6X1","M21.6X2","M24.572","M24.571","M79.671","M79.672","L60.0","G43.909","J44.9","M81.8","J67.9","K21.0","Z01.419","Z11.3","Z12.31","Z13.820","Q13.4","H25.13","H53.009","H55.00","R51.9","NO DATA","J30.89","H18.20","H40.053","M47.816"],"date":["2021-12-16","2021-04-15","2021-12-16","2021-12-16","2021-12-16","2021-08-17","2021-08-17","2021-12-16","2021-12-16","2021-08-17","2021-05-24","2021-05-24","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-08-17","2021-12-16","2021-10-05","2020-11-20","2020-08-06","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2021-10-06","2021-09-09","2021-09-09","2021-09-09","2020-10-26","2020-10-29","2021-04-15","2021-10-06","2021-10-06","2021-12-16"],"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":[["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","ATENOLOL","TAB 50MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","ESCITALOPRAM","TAB 5MG","","Select","Select",""],["","","MOMETASONE","SPR 50MCG","","Select","Select",""],["","","RISPERIDONE","TAB 2MG ODT","","Select","Select",""],["","","DICLOFENAC","TAB 100MG ER","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","ROSUVASTATIN","TAB 20MG","","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":""}]}]}