{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LEAHCIMTREBLOH R","gend":0,"add":"OEHT 6192TC SUROD","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1966-01-21","age":"","mstatus":"","insh":"1594410*63","cliId":"","pno":"67\/7575362-9","cno":"000-0000","email":"","ename":"","eno":"","pphy":"WATSON, NICOLE M NP","ppno":"757\/395-1300","pcpadd":"1975 GLENN MITCHELL DR STE 202","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"ACA","lob":"Small Group","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":["Z12.11","Z86.010","D12.3","D12.4","K62.1","Z12.5","R05.","I25.110","I25.82","I10.","K21.9","B19.20","R79.89","Z82.49","Z79.02","Z95.5","F17.200","Z79.82","Z79.899","I20.0","D48.5","L82.0","L21.9","L81.4","J30.1","J34.2","I25.10","I25.83","I70.213","M54.2","G47.9","R51.9","R07.9","R42.","I65.22","K22.8","R10.9","B18.2","I48.91","I73.9","E78.2","G89.29","Z00.00","I25.118","D22.9","I48.0","K63.5","I20.8","R07.89","I48.92","F17.210","K76.0","E78.5","Z86.718","Z79.01","R00.2","D17.0","L82.1","L91.8","Z71.9","Z72.0","Z72.89","R06.83","R22.9","Z76.89","T45.7X1A","D68.9","L73.8","K44.9","Z79.51","Z86.19","R06.09","Z12.2","R91.1","M47.812","K74.0","D12.8","Z87.891","K59.00"],"date":["2019-03-04","2019-03-04","2019-03-04","2019-03-04","2019-03-04","2019-08-01","2020-02-07","2019-12-13","2021-06-22","2021-07-30","2020-06-02","2020-06-02","2019-12-12","2020-06-02","2020-06-02","2020-06-02","2020-02-07","2019-12-12","2020-06-02","2019-12-12","2019-02-25","2019-02-25","2019-02-25","2019-02-25","2019-09-23","2019-09-23","2021-12-15","2021-03-22","2021-03-22","2021-07-30","2021-06-03","2021-06-03","2021-06-22","2021-10-19","2021-10-19","2019-01-22","2019-05-07","2021-04-28","2020-06-08","2021-02-09","2021-06-04","2019-01-04","2019-01-04","2021-07-30","2021-04-28","2021-12-15","2019-03-04","2021-06-04","2021-06-22","2020-06-02","2021-05-07","2021-05-07","2021-12-30","2020-06-02","2020-06-19","2020-06-12","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-04-28","2020-06-02","2020-09-23","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2019-02-25","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2021-05-07","2021-05-07","2021-05-07","2020-02-07","2019-03-04","2019-03-05","2019-08-06"],"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":[["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","90","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","-16","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","-30","Select","Select",""],["","65162025425","RANITIDINE","TAB 300MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","5","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","27241012502","RANOLAZINE","TAB 500MG ER","-180","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","68645056854","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","69238115403","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","61958100301","RANEXA","TAB 500MG","60","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","60","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":""}]}]}