{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S   LIRPANAHGUAV ","gend":1,"add":"UAL 318EVA LER","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1970-04-20","age":"","mstatus":"","insh":"3844110*21","cliId":"","pno":"0475745119","cno":"","email":"","ename":"","eno":"","pphy":"LAW, KATHERINE P MD","ppno":7574137600,"pcpadd":"5320 PROVIDENCE #301","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23464-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","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":["N39.3","N39.41","R10.2","N30.00","R39.15","M46.1","G57.31","M17.9","Z20.822","R07.9","M18.9","Z12.31","E11.9","I10.","E89.0","Z79.4","G47.33","Z00.00","E55.9","R09.81","L82.1","L81.4","D22.9","I78.1","Z11.59","E78.2","N18.9","R94.31","Z23.","E11.59","E11.69","Z12.11","Z86.16","F41.9","N95.1","G89.4","R31.9","Z99.89","N30.01","H10.13","L98.9","I15.2","E78.5","Z01.411","J00.","R00.2","E11.22","I12.9","E66.9","Z68.34","Z88.0","Z88.5","K57.30","K64.8","G57.30","M17.0"],"date":["2021-03-23","2021-02-25","2021-02-25","2021-02-25","2021-03-23","2022-07-28","2022-07-28","2021-10-05","2023-02-17","2021-09-15","2022-07-28","2023-03-24","2023-03-24","2021-06-10","2023-03-24","2023-03-24","2023-02-15","2023-03-24","2023-03-24","2022-01-27","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2021-05-04","2021-09-14","2023-03-24","2021-09-14","2022-03-25","2023-03-24","2023-03-24","2022-03-21","2021-11-09","2021-11-09","2022-04-05","2022-02-01","2021-02-25","2023-02-15","2023-03-07","2023-03-24","2023-03-24","2023-03-24","2023-03-24","2022-04-05","2023-02-17","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2022-03-21","2022-03-21","2021-03-04","2021-05-06"],"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":[["","69238183701","LEVOTHYROXIN","TAB 137MCG","90","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","68180013501","ESCITALOPRAM","TAB 10MG","45","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","49884012301","LABETALOL","TAB 200MG","360","Select","Select",""],["","65862047705","RAMIPRIL","CAP 10MG","180","Select","Select",""],["","00002871501","HUMULIN","INJ 70\/30","20","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","11917002536","INSULIN","MIS 0.5\/31G","100","Select","Select",""],["","58468009003","SYNVISC","INJ 8MG\/ML","6","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","69097067805","PREGABALIN","CAP 50MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","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":""}]}]}