{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  TTEIRRAHNIFFIRG M ","gend":1,"add":"EIFRAIRB 5851851 TPA DR DL","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1984-11-25","age":"","mstatus":"","insh":"28200210*48","cliId":"","pno":"23\/7577102-7","cno":"","email":"","ename":"","eno":"","pphy":"WALLACE, DAVID M MD","ppno":"757\/726-5000","pcpadd":"200 EATON ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Old Hampton","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F33.1","NO DATA","M25.559","Z86.2","Z76.0","G47.33","E11.69","D86.0","E66.9","D86.9","J06.9","B34.9","R53.83","R06.02","R11.2","F17.210","R11.0","F51.04","F43.10","H02.845","H02.844","H02.842","H02.841","H57.13","R09.81","K52.9","R05.","R06.83","R29.818","D64.9","E55.9","R51.9","R19.7","R07.9","R73.09","R60.0","R05.9","R42.","Z20.822","Z01.419","R60.9","M54.2","N94.9","E66.01","Z68.41","R06.00","R20.2","R20.0","R07.89","Z87.891","Z88.0","K02.9","R68.84","R10.12","R10.32","N39.0","R40.0","D86.3","G93.2","E11.9","G47.8","H02.849","Z00.00","Z11.3","F17.200","J41.0","M50.30","N64.4","M25.50","D50.0","Z79.899","F33.2","J20.8","B96.89"],"date":["2020-01-14","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-21","2020-03-31","2020-04-01","2020-09-24","2021-10-07","2019-11-14","2020-01-25","2019-11-14","2020-01-14","2020-01-14","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-03-19","2020-03-31","2020-09-24","2021-04-28","2021-04-28","2020-08-27","2021-10-20","2020-11-01","2020-11-01","2021-04-28","2021-04-28","2021-10-20","2021-10-20","2021-10-20","2021-10-26","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2021-03-23","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2020-02-07","2020-02-07","2020-05-10","2020-05-10","2019-07-27","2020-09-24","2020-09-24","2020-09-24","2021-10-26","2021-10-26","2020-01-25","2019-09-03","2019-09-03","2019-09-03","2019-09-03","2019-09-03","2019-09-03","2021-10-07","2021-11-15","2021-10-20","2019-05-26","2019-12-13","2019-12-13"],"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":[["","","PREDNISONE"," PREDNISONE ","40","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","69238106901","POT  CHLORIDE","TAB 20MEQ ER","20","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","VITAMIN"," VITAMIN ","12","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","12","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","METHOCARBAM","TAB 750MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","ACETAMIN","TAB 500MG","","Select","Select",""],["","","ERYTHROMYCIN","OIN 5MG\/GM","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","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":""}]}]}