{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RG EIRREHS ETIHW RAEE","gend":1,"add":"RGCM 805TC ROGE","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1958-03-19","age":"","mstatus":"","insh":"1623210*72","cliId":"","pno":"65\/7576551-7","cno":"757\/567-1556, 757\/567-1556, ","email":"","ename":"","eno":"","pphy":"PEARMAN, STEVEN D MD","ppno":"757\/252-9800","pcpadd":"1380 TUSCANY DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456-9998","pcpcounty":"","pcpid":117382,"pcpname":"SMG - Sentara Family Medicine Physicians - Nimmo","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.91","Z01.818","H54.7","I10.","E78.5","H25.9","E55.9","F32.1","H26.9","R76.8","H25.11","Z23.","Z48.89","M25.561","M17.11","Z20.828","U07.1","H25.13","H10.45","H02.882","H04.123","R53.83","Z00.00","R73.09"],"date":["2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-06-09","2020-11-11","2020-11-11","2020-12-22","2020-12-22","2021-02-17","2021-02-17","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-04-19","2021-04-19","2021-04-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","00378427693","VALACYCLOVIR","1GM","30","Select","Select",""],["","72205002290","ATORVASTATIN","10MG","90","Select","Select",""],["","29300013601","CLONIDINE","0.2MG","30","Select","Select",""],["","70436001004","BUPROPN","150MG XL","90","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","30","Select","Select",""],["","53746064201","FLECAINIDE","100MG","180","Select","Select",""],["","16729017001","ESCITALOPRAM","20MG","90","Select","Select",""],["","68180021509","LOSARTAN\/HCT","50-12.5","90","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","-180","Select","Select",""],["","65162019010","NAPROXEN","500MG","60","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","00115151866","ESTRADIOL","0.01%","42","Select","Select",""],["","70069009101","AZELASTINE","0.05%","6","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","-90","Select","Select",""],["","42192033901","HYOSCYAMINE","0.125MG","100","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","10","Select","Select",""],["","67877056105","METFORMIN","500MG","180","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}