{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"P   NWAHSSRETTAW ","gend":0,"add":"H XOF 2283DAOR WOLLO","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1959-03-31","age":"","mstatus":"","insh":"0103220*94","cliId":"","pno":"65\/7577460-4","cno":"757\/564-0647","email":"","ename":"","eno":"","pphy":"PERKINS, LORRAINE K NP","ppno":"757\/220-2795","pcpadd":"STE 200 4374 NEW TOWN AVE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - New Town","plan":"OHP","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":["I73.9","F17.211","Z87.891","E11.51","J41.0","E27.8","I25.119","E11.22","R80.9","I10.","E78.2","N18.31","Z79.4","E11.21","R97.20","I70.8","I77.1","Z00.00","D12.6","K76.0","R79.89","E11.29","E11.9","I70.201","D48.5","L57.0","N48.1","D22.39","L82.1","L81.4","D18.00","D22.9","Z85.828","Z12.83","Z71.9","L30.8","Z23.","G47.33","M10.00","E66.09","R09.89","E11.36","Z79.84","H25.813","H52.13","H52.203","H52.4","R91.1","J84.9","Z68.30","L30.9","D18.01","L30.0","Z48.02","L82.0","Z12.11"],"date":["2021-07-12","2022-01-04","2021-12-21","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2021-05-10","2021-11-15","2021-07-08","2021-07-08","2022-01-04","2021-11-15","2021-11-15","2021-11-15","2022-03-16","2021-11-15","2021-11-15","2021-02-22","2021-06-22","2022-02-22","2021-02-22","2022-02-22","2022-02-22","2021-02-22","2022-02-22","2022-02-22","2022-02-22","2022-03-08","2022-02-22","2021-11-17","2022-01-04","2021-05-10","2021-05-10","2021-06-02","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2022-01-04","2022-01-04","2022-01-04","2022-02-22","2022-02-22","2022-03-08","2022-03-08","2021-02-22","2021-05-23"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00006057761","JANUMET","TAB 50-1000","180","Select","Select",""],["","16729000515","SIMVASTATIN","TAB 20MG","135","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","60631042530","EDARBYCLOR","TAB 40-25MG","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","51","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","50742061601","METOPROL","TAB 50MG ER","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","51672411806","FLUOROURACIL","CRE 0.05","-40","Select","Select",""],["","31722064630","TADALAFIL","TAB 20MG","12","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","-1","Select","Select",""],["","08496320101","EASY","MIS 32GX5MM","-100","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","50228014605","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","08489831410","PEN  NEEDLES","MIS 32GX5MM","-100","Select","Select",""],["","68180021609","LOSARTAN\/HCT","TAB 100-12.5","90","Select","Select",""],["","27808015701","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","31722015490","VALSARTAN","TAB 320MG","-90","Select","Select",""],["","62332008090","VALSART\/HCTZ","TAB 160-12.5","90","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":""}]}]}