{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNETTE  I HOLT","gend":1,"add":"ANNETTE HOLT","city":"CAPRON","state":"VA","zip":"23829-9998","dob":"1960-03-25","age":"","mstatus":"","insh":"6808077*01","cliId":"","pno":4345948084,"cno":4345948084,"email":"","ename":"","eno":"","pphy":"LAO, HAYES Y MD","ppno":7575622158,"pcpadd":"102 FAIRVIEW DR STE B,","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":"23851-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Hospital Medicine Physicians - SOH","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575168019,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","I10.","Z12.11","R06.2","Z68.26","Z72.0","D48.9","L82.1","L81.4","L30.9","Z79.899","J34.89","R73.03","R68.89","Z13.220","E55.9","Z68.23","E11.9","H25.13","H52.7","F17.200","Z71.6","J43.9","Z12.31","D04.39","K64.1","Z12.2","F17.210","Z01.812","Z20.822","Z79.84","Z88.5","Z88.8","K64.8","J84.9","U07.1"],"date":["2022-08-26","2022-12-01","2021-08-25","2022-09-30","2021-07-26","2021-07-26","2022-12-21","2022-12-21","2022-12-21","2022-09-30","2022-09-30","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-03-02","2023-06-19","2022-03-02","2022-08-26","2022-05-26","2022-08-26","2022-08-26","2023-04-11","2021-08-25","2022-06-20","2022-06-20","2022-09-13","2022-09-13","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2022-06-20","2022-09-13"],"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":[["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","64980034214","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00168000215","TRIAMCINOLON","CRE 0.005","15","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","43547028910","BUPROPION HCL SR","150 MG","180","Select","Select",""],["","64980034214","ALENDRONATE TAB","70MG","12","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","29300012810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","00378718505","METFORMIN TAB","500MG","90","Select","Select",""],["","43547028910","BUPROPION TAB","150MG SR","60","Select","Select",""],["","00168000215","TRIAMCINOLON CRE","0.5%","15","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","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":""}]}]}