{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONIQUE V CARTER-WOLFE","gend":1,"add":"345 DUNNING ST","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1991-11-27","age":"","mstatus":"","insh":"1389577*01","cliId":"","pno":7572562001,"cno":7572562001,"email":"","ename":"","eno":"","pphy":"BETZ, MICHELLE K DO","ppno":7572529140,"pcpadd":"STE 202 301 RIVERVIEW AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23510-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Neurology Specialists - Princess Anne","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574317752,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","H16.223","H17.89","V58.89","V54.19","G35.","Z91.09","F17.290","H66.003","J03.90","R51.9","J02.0","R05.9","R26.9","R23.8","H53.8","H92.02","J02.9","F17.210","L53.9","Z20.822","R50.9","S32.2XXA"],"date":["2022-11-09","2022-03-11","2022-03-11","2022-10-12","2022-10-12","2022-11-09","2022-10-12","2022-11-09","2023-03-19","2022-11-09","2023-03-19","2023-03-19","2023-03-19","2021-12-03","2021-12-03","2021-12-03","2023-05-13","2023-05-13","2023-05-13","2023-05-13","2023-03-19","2023-03-19","2022-10-12"],"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":[["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","20","Select","Select",""],["","67877054360","CEFDINIR","300 MG","20","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","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":""}]}]}