{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARNIDA  M HAWKINS","gend":1,"add":"169 MYTELINE DR","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1989-11-27","age":"","mstatus":"","insh":"3150852*01","cliId":"","pno":7577743979,"cno":7577743979,"email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":7575941850,"pcpadd":"STE 100 11803 JEFFERSON AVE,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575941841,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","R10.30","F41.9","F32.9","Z87.891","Z79.899","M54.2","V89.2XXD","M25.512","Z00.00","R10.9","R61.","R19.7","Z11.3","Z11.4","N92.6","J30.9","E66.01","F25.9","M25.511","G89.29","R10.84","R07.89","R10.2","R51.9","R10.816","R11.10"],"date":["2023-01-03","2022-06-16","2021-10-17","2021-10-17","2022-06-16","2021-10-17","2022-07-29","2022-07-29","2022-07-29","2021-09-16","2022-06-16","2022-06-16","2022-06-16","2021-01-28","2021-01-28","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2021-07-15","2021-07-15","2021-10-17","2022-05-06","2022-05-06","2022-05-06","2023-01-03","2023-01-03"],"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":[["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","11822060537","ALLERGY REL","TAB 10MG","90","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","68180035306","SERTRALINE","TAB 100MG","30","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","70010013901","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE","10 MG","10","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","20","Select","Select",""],["","65862052790","VENLAFAXINE CAP","37.5 ER","30","Select","Select",""],["","68180035306","SERTRALINE TAB","100MG","30","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","60","Select","Select",""],["","11822060537","ALLERGY REL TAB","10MG","90","Select","Select",""],["","51660093901","CETIRIZINE TAB","10MG","30","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","90","Select","Select",""],["","16571020110","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","15","Select","Select",""],["","70010013901","NAPROXEN TAB","500MG","20","Select","Select",""],["","11822060537","ALLERGY RELIEF","10 MG","30","Select","Select",""],["","14539067501","HYDROXYZINE PAMOATE","50 MG","30","Select","Select",""],["","13668013501","ESCITALOPRAM OXALATE","5 MG","30","Select","Select",""],["","31722082030","ARIPIPRAZOLE","5 MG","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":""}]}]}