{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NHAJXOF ","gend":0,"add":"POH 988NL DOOW","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1979-07-12","age":"","mstatus":"","insh":"8548110*75","cliId":"","pno":"47\/7577761-8","cno":"","email":"","ename":"","eno":"","pphy":"WILLIAMS, HARRY T MD","ppno":"757\/395-1300","pcpadd":"2859 VA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.512","F32.0","F41.9","R79.89","K76.0","G47.09","M25.462","M12.812","H66.003","N52.9","F10.920","F14.90","R25.1","S46.912A","F43.10","Z88.6","Z88.8","M54.2","H53.9","R14.0","R42.","R93.0","H93.19","Z20.2","R36.9","R21.","E78.00","Z20.828","H65.01","Z23.","M23.91","R10.11"],"date":["2020-05-21","2021-08-16","2021-09-01","2020-05-21","2021-09-01","2020-06-04","2021-09-23","2020-08-26","2020-09-07","2021-08-16","2020-06-07","2020-06-07","2020-06-07","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-09-27","2021-09-27","2021-09-01","2021-09-01","2021-02-22","2019-04-07","2019-08-15","2019-03-29","2019-08-15"],"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":[["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","","ALPRAZOLAM","TAB 0.25MG","","Select","Select",""],["","70710116201","MECLIZINE","TAB 25MG","30","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","65862064130","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","CHLORDIAZEP","CAP 5MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","FLUBLOK","INJ 2020-21","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","TADALAFIL","TAB 20MG","","Select","Select",""],["","","AMOX\/K","TAB 500-125","","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","60","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":""}]}]}