{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WHITNEY REYNOLDS","gend":1,"add":"928 MONARCH DRIVE                                           ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23462-7316","dob":"1990-07-25","age":"","mstatus":"","insh":10198733,"cliId":"","pno":5409079712,"cno":5409079712,"email":"","ename":"","eno":"","pphy":"GATA JR., RENATO G                                          ","ppno":"","pcpadd":"858 J Clyde Morris Blvd,STE 114","pcpcity":"Newport News                  ","pcpstate":"VA","pcpzip":236011303,"pcpcounty":"","pcpid":"P9634587","pcpname":"SENTARA FAMILY MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"928 MONARCH DRIVE                                           ","madd2":"                                                            ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23462-7316","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.552","W19.XXXA","S70.02XA","S80.12XA","W01.0XXA","F17.200","R05","Z20.828","Z01.419","Z11.51","Z11.3","Z13.89","E55.9","O20.0","O20.9","O26.899","R25.2","R93.89","N83.291","Z90.49","Z87.891","Z3A.01","R10.2","Z3A.00","O36.80X0","O26.851","O36.80X9","O46.90","O02.81","O02.1","B37.3","N89.8","F43.21","R07.9","R11.0","B34.9","R68.83","R07.0","R53.83","M79.10","R51.9","R11.2","R63.0","R30.9"],"date":["2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2021-04-16","2021-06-07","2021-06-07","2020-10-05","2020-10-02","2020-10-02","2020-10-05","2020-10-05","2020-10-09","2020-10-23","2020-10-08","2021-08-21","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-23","2020-10-08","2020-10-10","2020-10-23","2020-10-10","2020-11-05","2020-10-23","2020-10-30","2020-11-19","2021-11-03","2021-07-01","2021-03-02","2021-04-16","2021-04-16","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-11-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","80777027315","MODERNA","COVID-19","0.5","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","71093014105","METHOCARBAM","750MG","20","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","59762305102","AZITHROMYCIN","1GM PAK","1","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","80777027315","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","71093014105","METHOCARBAM ","TAB 750MG","20","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","59762305102","AZITHROMYCIN ","POW 1GM PAK","1","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}