{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AICILEFTTEREVE","gend":1,"add":"EK W 212EVA YLL","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1979-03-22","age":"","mstatus":"","insh":"6563110*84","cliId":"","pno":"29\/7574228-0","cno":"","email":"","ename":"","eno":"","pphy":"GEORGE, DYLAN M NP","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":"M4","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":["Z00.00","E66.01","E55.9","Z12.39","G43.109","B37.2","Z68.41","M54.12","M43.22","Z11.3","N76.0","B96.89","K64.5","F17.200","Z90.710","R10.30","J47.9","R93.89","R06.02","K21.9","V58.89","J43.9","J98.4","D64.9","I77.74","D32.9","M48.02","K62.5","Z72.0","F41.9","N95.1","F32.9","M54.2","S39.011A","N30.01","Z71.1","Z71.89","Z12.31","J01.90","B97.89","M54.6","Z71.6","K64.8","K64.4","R07.89","F41.1","R94.31","R07.9","N62.","R10.32","R10.13","K57.90","G43.009","N39.0","R31.9","K57.30","R11.2"],"date":["2020-09-03","2021-04-22","2021-04-22","2020-09-03","2020-11-04","2020-12-30","2021-04-22","2021-01-19","2021-01-19","2021-07-22","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-04-22","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-06-09","2021-06-09","2021-06-09","2020-02-21","2020-05-16","2020-05-16","2020-11-04","2020-11-04","2020-11-04","2020-12-30","2020-12-30","2021-03-03","2020-12-30","2021-05-24","2021-05-24","2021-06-01","2019-04-24","2019-10-25","2019-10-22","2019-08-28","2019-11-11","2019-07-16","2019-07-16","2019-06-27","2019-07-12","2019-07-12","2019-07-12","2019-07-12"],"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":[["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","00574709012","HYDROCORT","SUP 25MG","14","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","68308015260","NYSTATIN","POW 100000","60","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","23","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","30","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":""}]}]}