{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRAIG   A MORRISETTE","gend":0,"add":"1052 CHINQUAPIN LN","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1960-02-10","age":"","mstatus":"","insh":"1002916*01","cliId":"","pno":"435-0495","cno":"435-0495","email":"","ename":"","eno":"","pphy":"BAKHSHI, RAJA M MD","ppno":"757\/395-6900","pcpadd":"984B LASKIN ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":117346,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"481-9199","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":["J93.9","T81.82XA","J93.83","R07.9","J95.811","Z46.82","Z45.2","Z98.890","J43.9","F17.200","Z85.53","H31.003","H43.393","J93.11","F17.210","Z85.528","Z90.5","J44.9","I10.","K80.20","T79.7XXD","J98.11","R00.1","Z90.2","R11.0","J98.2","Z09.","R10.31","Z68.29","K81.1","Z20.822","Z90.49","K80.11","K80.10","Z87.891","K81.9"],"date":["2021-01-11","2021-01-11","2021-01-27","2021-06-28","2021-01-02","2020-12-29","2020-12-29","2021-01-04","2021-06-28","2021-01-04","2021-01-04","2020-03-09","2020-03-09","2020-12-24","2021-06-28","2021-06-28","2021-10-20","2020-12-29","2020-12-29","2021-06-28","2021-01-11","2020-12-24","2021-06-28","2021-06-28","2021-06-28","2020-12-28","2021-01-27","2021-01-27","2021-01-27","2021-10-22","2021-10-18","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20"],"priorHcc":["","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null,null,null,null,null,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":[["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","65162046550","IBUPROFEN","600MG","9","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","65162046550","IBUPROFEN ","TAB 600MG","9","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}