{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  IKAHSATTOCS L ","gend":1,"add":"TSAE 27422TS TOPED ","city":"NEWSOMS","state":"VA","zip":"23874-9998","dob":"1978-02-22","age":"","mstatus":"","insh":"1818910*83","cliId":"","pno":"55\/7577225-6","cno":"757\/758-9027","email":"","ename":"","eno":"","pphy":"REIMER, LORI NP","ppno":"757\/252-9500","pcpadd":"BUILDING 16 6333 CENTER DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Comprehensive Weight Loss Solutions - Norfolk","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["R60.0","I87.2","R60.9","D68.61","Z79.01","Z86.79","NO DATA","I63.9","I70.1","D68.62","E78.2","D63.1","E61.1","R79.89","I51.7","I34.0","I12.9","N18.3","Z71.9","E66.9","I10.","O90.3","I50.41","K21.9","I42.9","I50.22","R06.02","Z23.","E66.01","D64.9","M25.552","R25.2","R26.2","M54.5","I11.0","I50.9","Z86.73","R68.89","Z68.41","F32.9","Z68.39","J32.9","E78.5","L02.612","L60.0","J06.9","Z01.411","N89.8"],"date":["2020-01-23","2019-04-18","2019-04-18","2021-12-28","2021-03-11","2021-12-28","2021-12-13","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-12-28","2019-09-05","2019-09-23","2019-09-23","2021-12-13","2020-04-15","2021-12-13","2021-12-13","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2020-05-08","2019-09-23","2019-02-05","2019-09-17","2020-09-14","2019-08-07","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-09-29","2020-09-14","2020-09-29","2020-09-29","2019-03-03","2020-04-15","2021-02-12","2021-02-12","2020-01-10","2021-11-08","2021-11-08"],"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":[["","","CLONIDINE"," CLONIDINE ","60","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","90","Select","Select",""],["","","HYDRALAZINE"," HYDRALAZINE ","120","Select","Select",""],["","","RA"," RA ","30","Select","Select",""],["","","CARVEDILOL"," CARVEDILOL ","60","Select","Select",""],["","","EZETIMIBE"," EZETIMIBE ","30","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","FERROUS"," FERROUS ","30","Select","Select",""],["","","SPIRONOLACT"," SPIRONOLACT ","30","Select","Select",""],["","","WARFARIN"," WARFARIN ","30","Select","Select",""],["","","ISOSORB"," ISOSORB ","30","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","METHYLPRED"," METHYLPRED ","21","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","30","Select","Select",""],["","","BUMETANIDE"," BUMETANIDE ","30","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","TERBINAFINE"," TERBINAFINE ","30","Select","Select",""],["","","FEROSUL"," FEROSUL ","30","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","VIRTUSSIN","SOL 100-10\/5","","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":""}]}]}