{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEANDRE  A CREDLE","gend":1,"add":"2510 COLOUMBIA AVE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1962-12-11","age":"","mstatus":"","insh":"20083533*01","cliId":"","pno":7574073922,"cno":7574073922,"email":"","ename":"","eno":"","pphy":"TISDALE, JENNIFER N PAC","ppno":7573889925,"pcpadd":"7401 GRANBY ST,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579658519,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.69","Z23.","E11.9","M05.79","F31.75","E78.5","I10.","R22.42","Z79.899"],"date":["2022-07-29","2022-07-29","2022-07-29","2023-04-21","2022-07-29","2022-07-29","2023-04-27","2023-04-27","2023-04-21"],"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":[["","70377002811","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","43547030703","ARIPIPRAZOLE","30 MG","30","Select","Select",""],["","59651017401","DOXEPIN HCL","25 MG","30","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","60","Select","Select",""],["","70436006001","BUPROPION","TAB 200MG SR","60","Select","Select",""],["","70436006001","BUPROPION HCL SR","200 MG","60","Select","Select",""],["","70377002813","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","43598072101","HYDROXYCHLOROQUINE SULFATE","200 MG","60","Select","Select",""],["","69097083512","SERTRALINE HCL","100 MG","60","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","76385012450","METHOCARBAMOL","750 MG","28","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","70377002811","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","70436006001","BUPROPION TAB","200MG SR","60","Select","Select",""],["","59651017401","DOXEPIN HCL CAP","25MG","30","Select","Select",""],["","69097083512","SERTRALINE TAB","100MG","60","Select","Select",""],["","43547030703","ARIPIPRAZOLE TAB","30MG","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":""}]}]}