{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW  L CREWS","gend":0,"add":"1226 N MALLORY ST","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1972-07-07","age":"","mstatus":"","insh":"2489343*01","cliId":"","pno":7575945716,"cno":7575945716,"email":"","ename":"","eno":"","pphy":"FRANCIS, ALBERT H MD","ppno":7577363700,"pcpadd":"2104 EXECUTIVE DRIVE","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","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":7578279978,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","C90.00","Z51.12","Z23.","Z92.21","R06.09","R06.2","F17.210","J98.4","R94.31","R79.89","A41.9","J18.9","E87.6","J43.2","J15.9","D80.1","S22.39XA","J43.9","I70.0","D64.9","Z20.822","Z88.0","Z88.6","Z82.49","Z80.9","F17.200","Z51.11","Z79.899","I34.0","I36.1","C90.01","B01.89","B02.29","F12.920","Z98.890","C79.49","G64.","I42.8","I73.9","Z45.2","R11.0","K59.03","G89.3"],"date":["2023-02-16","2023-04-12","2023-01-12","2022-12-29","2022-11-25","2023-04-12","2023-01-24","2023-01-24","2023-01-24","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2022-12-29","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-03-10","2023-03-10","2023-02-16","2023-02-16","2023-02-16","2023-03-10","2023-01-26","2023-01-26","2023-01-26","2023-02-17","2023-01-26","2023-01-26","2023-03-29","2023-03-17","2022-11-03","2023-03-29","2023-04-12","2023-04-19","2023-03-17","2023-01-26","2023-01-26","2023-03-29"],"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":[["","65862052301","GABAPENTIN","600 MG","90","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","200","Select","Select",""],["","70436015301","POT CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","47469000312","ALPHA LIPOIC","CAP 300MG","60","Select","Select",""],["","60219204301","DEXAMETHASON","TAB 4MG","80","Select","Select",""],["","63304045101","MORPHINE SUL","TAB 30MG ER","90","Select","Select",""],["","57237004330","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","100","Select","Select",""],["","60505265701","TRIAMTERENE-HYDROCHLOROTHIAZID","75 MG-50MG","90","Select","Select",""],["","10702005601","OXYCODONE HCL","10 MG","200","Select","Select",""],["","70436015301","POTASSIUM CHLORIDE","20 MEQ","60","Select","Select",""],["","60219204301","DEXAMETHASONE","4 MG","80","Select","Select",""],["","00378193728","LENALIDOMIDE","10 MG","28","Select","Select",""],["","70752018012","CODEINE-GUAIFENESIN","10-100MG\/5","180","Select","Select",""],["","55111028130","LEVOFLOXACIN","750 MG","5","Select","Select",""],["","59572041028","REVLIMID","10 MG","21","Select","Select",""],["","00121086816","NYSTATIN","100000\/ML","400","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":""}]}]}