{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN  M WEST","gend":1,"add":"10256 JENNINGS LN RM 44","city":"HAYES","state":"VA","zip":"23072-9998","dob":"1977-08-12","age":"","mstatus":"","insh":"20037148*01","cliId":"","pno":7577595919,"cno":7577595919,"email":"","ename":"","eno":"","pphy":"GOMEZ, BRANDI D NP","ppno":8042101025,"pcpadd":"5659 PARKWAY DR STE 210","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":"23061-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Gloucester","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042101029,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","M15.8","G89.4","E66.01","Z13.6","K86.1","J44.9","M25.50","G89.29","Z96.643","Z79.891","M08.00","I50.30","F11.10","Z99.81","G47.33","L03.116","Z87.39","Z68.44","Z86.16","Z79.82","Z79.899","E66.2","R09.02","J42.","Z68.43","I27.81","M91.10","I50.9","R60.9","R07.9","Z20.828","NO DATA","M25.561","M25.562","M25.551","M25.552","E61.1","M16.0","R09.89","G47.8","G47.10","I11.0","F17.210","Z71.82","U07.1","R50.9","M81.0","J45.909","K21.9","Z88.6","R06.02","E55.9","M79.89","R07.89","R60.0","M79.604","F17.200","Z20.822","Z47.1","E87.6"],"date":["2021-05-12","2021-05-12","2022-06-22","2023-03-23","2021-05-12","2021-05-12","2023-03-19","2021-12-02","2023-01-10","2023-03-23","2023-01-10","2023-03-23","2022-09-08","2022-09-08","2022-09-08","2022-10-27","2023-03-23","2021-12-02","2022-10-27","2022-10-27","2022-10-27","2023-01-10","2022-10-27","2023-01-10","2023-01-10","2023-03-23","2022-06-22","2022-06-22","2022-10-27","2022-06-22","2022-06-29","2022-05-09","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2022-10-27","2022-10-27","2022-10-27","2023-01-10","2023-01-10","2022-01-01","2022-01-01","2022-06-29","2022-01-01","2022-01-01","2022-01-01","2022-01-01","2022-04-29","2022-06-29","2022-06-29","2022-06-29","2022-06-29","2022-06-29","2022-05-09","2023-03-23","2023-03-14"],"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":[["","68180051303","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","00406577101","METHADONE","TAB 10MG","150","Select","Select",""],["","00363056317","ASPIRIN LOW","TAB 81MG EC","90","Select","Select",""],["","00406853001","OXYCODONE","TAB 30MG","120","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","50111091701","TORSEMIDE","20 MG","210","Select","Select",""],["","00406577101","METHADONE HCL","10 MG","150","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","28","Select","Select",""],["","00406853001","OXYCODONE HCL","30 MG","120","Select","Select",""],["","69680013300","POTASSIUM CHLORIDE","10 MEQ","60","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":""}]}]}