{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D ADLEMIZURC ALE","gend":1,"add":" RIS 5235RD NOTRAB","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1969-11-13","age":"","mstatus":"","insh":"5820210*51","cliId":"","pno":"1475717226","cno":"","email":"","ename":"","eno":"","pphy":"ROBLEDO, ELIZABETH MD","ppno":7573951700,"pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","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":["I10.","Z00.00","E78.2","E66.09","R25.2","Z12.11","K21.9","M25.511","Z11.59","Z68.30","G89.29","M25.512","M25.561","Z68.31","Z12.31","H81.10","R11.2","Z79.899","E66.9","Z82.49","Z91.013","Z91.018","R91.8","Z87.01","K31.89","K29.70","G47.33","R42.","J98.4","R06.02","J06.9","R06.2","M54.9","Z78.9","Z99.89","M17.11","Z13.828","J45.20","Z87.898","R06.83","J34.89","R68.2","Z23.","R29.818","M25.562","Z86.16","Z91.09","K64.8","R11.0","J98.09"],"date":["2023-03-13","2021-06-29","2022-05-18","2022-05-18","2021-06-29","2021-08-17","2022-12-28","2021-06-29","2021-06-29","2022-05-18","2021-10-21","2021-06-29","2021-10-21","2022-03-27","2022-11-30","2022-03-27","2022-03-27","2022-03-27","2022-12-28","2022-03-27","2022-03-27","2022-03-27","2021-04-02","2021-04-02","2021-10-04","2021-10-04","2023-03-28","2022-11-08","2022-06-09","2022-06-09","2023-03-20","2021-03-29","2021-03-29","2023-03-28","2023-03-28","2022-02-10","2021-10-28","2022-05-26","2022-05-18","2021-12-21","2022-07-27","2022-07-27","2021-10-21","2021-10-21","2021-10-21","2022-01-24","2022-01-24","2021-08-17","2022-03-21","2022-05-26"],"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":[["","00054012522","LOSARTAN","TAB 100MG","90","Select","Select",""],["","65862006299","METOPROL","TAB 25MG","180","Select","Select",""],["","16714073201","CELECOXIB","CAP 100MG","180","Select","Select",""],["","00591034701","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","69543025204","VIRTUSSIN","SOL 100-10\/5","236","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","50383008716","GUAIATUSS","SYP 100-10\/5","240","Select","Select",""],["","69452014420","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","62542030117","HYD","SUS 10-8\/5ML","115","Select","Select",""],["","68585000801","ZINC","CAP 220MG","30","Select","Select",""],["","70710116201","MECLIZINE","TAB 25MG","30","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","80777027398","MODERNA","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":""}]}]}