{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NUH LEAHCIM NETSIAH RET","gend":0,"add":"VAH 9252DAOR NE","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1983-10-18","age":"","mstatus":"","insh":"6799110*70","cliId":"","pno":"76\/7571111-2","cno":"757\/672-1111, ","email":"","ename":"","eno":"","pphy":"ONAYEMI, OLUSOLA K MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","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":["Z01.818","K21.9","J01.90","R05.","K44.9","J20.9","R04.2","Z01.812","Z20.822","N36.9","F43.20","R10.13","R07.89","R11.2","R94.5","E86.0","F17.210","Z87.11","R10.11","J44.9","Z96.642","Z82.49","Z88.2","Z88.4","Z88.5","R79.89","R07.9","K21.0","K66.0","K31.89","Z79.899","Z45.89","Z98.890","R19.7","Z20.828","H02.59","R51.","H52.03","H52.223","Z03.818","Z11.59","E66.9","Z71.3","K22.4","M25.372","T84.84XD","G43.909","F12.929","F10.10","Z82.5","Z88.8"],"date":["2021-05-22","2021-05-26","2020-10-29","2020-10-29","2020-05-14","2021-04-24","2021-04-24","2021-05-22","2021-05-22","2021-05-27","2020-07-16","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-26","2021-05-15","2021-05-15","2021-05-26","2021-05-26","2021-05-15","2021-05-15","2021-05-15","2021-05-26","2021-05-15","2021-05-15","2020-05-14","2021-05-26","2020-05-14","2021-05-26","2021-05-26","2021-05-27","2020-05-11","2020-11-14","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2020-08-14","2020-08-14","2020-10-12","2020-10-12","2020-02-26","2020-03-23","2020-03-23","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-05-26"],"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":[["","64764017530","DEXILANT","60MG DR","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","25","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","60432060416","PROMETHAZINE","DM","120","Select","Select",""],["","00536589588","NICOTINE","14MG\/24H","-30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","-30","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","6","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","",""],["No","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":""}]}]}