{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUDRY SCANLON BANAKAS","gend":1,"add":"913 VIRGINIA BEACH BLVD TRLR 99","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1959-07-18","age":"","mstatus":"","insh":"2510315*01","cliId":"","pno":7573548756,"cno":7573548756,"email":"","ename":"","eno":"","pphy":"BAKHSHI, RAJA M MD","ppno":7573956900,"pcpadd":"984B LASKIN ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23451-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574257180,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C22.1","D64.81","G89.3","C18.9","Z51.11","Z51.12","H93.293","H93.13","C78.7","C78.6","C79.51","S06.5X9A","C79.72","M54.2","R59.9","Z92.21","R22.1","M84.522A","C16.9","Z87.891","Z92.3","M79.622","H53.8","R41.89","Z98.890","Z79.899","Z95.828","S42.392A"],"date":["2023-04-19","2023-01-10","2023-01-10","2022-12-12","2023-04-17","2023-02-24","2023-03-08","2023-03-08","2023-04-14","2023-04-14","2023-04-14","2023-02-15","2023-02-22","2023-02-22","2023-03-09","2023-03-09","2023-03-23","2023-04-13","2023-04-13","2023-04-13","2023-04-13","2023-04-13","2023-03-22","2023-03-22","2023-03-22","2023-03-22","2023-03-22","2023-04-13"],"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":[["","31722099601","HYDROCO\/APAP","TAB 5-325MG","42","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","55111016330","OLANZAPINE","TAB 2.5MG","30","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","120","Select","Select",""],["","65862039110","ONDANSETRON ODT","8 MG","30","Select","Select",""],["","50742050510","SCOPOLAMINE","1 MG\/3 DAY","3","Select","Select",""],["","00067434604","TRANSDERM-SCOP","1 MG\/3 DAY","3","Select","Select",""],["","00406831501","MORPHINE SULFATE ER","15 MG","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":""}]}]}