{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARA   M BOGGS","gend":1,"add":"321 SEA SCAPE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1985-04-20","age":"","mstatus":"","insh":"1072538*01","cliId":"","pno":"757\/572-2291","cno":"757\/572-2291","email":"","ename":"","eno":"","pphy":"ALPER, JASON B DO","ppno":"757\/395-2500","pcpadd":"1024 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117368,"pcpname":"SMG - Sentara Family Medicine Physicians - First Colonial","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/572-2291","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":["Q21.3","I51.7","Z95.2","J32.4","J45.41","R10.2","Z87.74","N83.209","L71.9","L85.8","K13.0","Z71.9","J06.9","J01.90","Z01.419"],"date":["2021-06-15","2021-06-15","2021-06-15","2021-07-15","2021-07-15","2021-08-27","2021-08-27","2021-08-27","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-11","2021-11-11","2021-11-09"],"priorHcc":["","","","","","","","","","","","","","",""]}},{"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":[["","00173071620","ADVAIR ","115\/21","-12","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","-16","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","60505082701","IPRATROPIUM ","0.06%","15","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00173071620","ADVAIR","115\/21","-12","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","-16","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","60505082701","IPRATROPIUM","0.06%","15","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","0","","","410","Select","Select",""],["","66993096045","METRONIDAZOL","0.75%","45","Select","Select",""],["","66993096045","METRONIDAZOL ","CRE 0.0075","45","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0","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","",""],["No","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":""}]}]}