{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   H SAWYER","gend":0,"add":"2380 PRINCESS ANNE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1967-01-05","age":"","mstatus":"","insh":"1111102*01","cliId":"","pno":"757\/286-2779","cno":"757\/286-2779","email":"","ename":"","eno":"","pphy":"SUN, TOMMY MD","ppno":"757\/507-0305","pcpadd":"STE 300 1950 GLENN MITCHELL","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":140395,"pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"427-1151","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-0306","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","S51.811A","R05.","R43.0","R43.2","M79.10","T14.90XA","S59.911A","H40.003","Z87.891","Z23.","M25.511","G89.29","Z01.818","M75.121","M67.813","M19.011","Z13.89","M75.51","S46.211A","M75.41","M75.21","S46.111A","S43.491A","M25.811","G89.18","K51.90","R11.2","Z98.890"],"date":["2020-12-24","2020-02-18","2020-11-25","2020-11-25","2020-11-25","2020-11-25","2020-02-05","2020-02-05","2021-03-15","2020-02-05","2020-02-05","2021-10-08","2021-09-23","2021-09-23","2021-10-05","2021-10-05","2021-09-03","2021-09-03","2021-09-03","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-09-23","2021-09-23","2021-09-23"],"priorHcc":["","","","","","","","","","","",null,null,"",null,null,"","","",null,null,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":[["","00054007928","BALSALAZIDE","750MG","280","Select","Select",""],["","65162019010","NAPROXEN","500MG","20","Select","Select",""],["","00143980350","DOXYCYCL","100MG","20","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","00054007928","BALSALAZIDE ","750MG","-280","Select","Select",""],["","00143980350","DOXYCYCL ","100MG","20","Select","Select",""],["","65162019010","NAPROXEN ","500MG","-20","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","68382005001","MELOXICAM ","7.5MG","60","Select","Select",""],["","68382005001","MELOXICAM","7.5MG","60","Select","Select",""],["","00536105429","ASPIRIN","325MG","28","Select","Select",""],["","00904699860","DOCUSATE","100MG","28","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","6","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","6","Select","Select",""],["","00904699860","DOCUSATE ","CAP 100MG","28","Select","Select",""],["","00536105429","ASPIRIN ","TAB 325MG","28","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":""}]}]}