{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORI PANTHER-RUDIGER","gend":1,"add":"2424 OCEAN SHORES CRES APT 202","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1969-07-04","age":"","mstatus":"","insh":"1142224*21","cliId":"","pno":"757\/651-3042","cno":"757\/651-3042","email":"","ename":"","eno":"","pphy":"WOODS, DAVID W MD","ppno":"757\/363-6800","pcpadd":"#100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":101283,"pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9029","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H16.223","H25.13","H52.4","I10.","Z23.","E03.9","Z78.0","D50.9","J30.1","I72.5","F41.9","G47.00","Z13.220","N30.00","R10.13","N39.0","Z72.89","R82.71","A41.9","R06.02","I67.1","R51.9","D48.5","D22.9","L82.1","R82.90","R82.81","R11.0","M54.2","R07.9","R00.2","Z79.899","Z88.0","Z88.8","Z91.040","Z91.048","F32.1","Z12.11","Z12.31","R06.00","R65.10","Z87.01","Z82.49","Z79.890","R30.0","R50.9","K21.9","R42.","R63.5","F32.5","H10.13","N64.4","Z80.3"],"date":["2020-02-05","2020-02-05","2020-02-05","2021-11-01","2020-11-02","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-02-25","2021-04-07","2021-04-29","2021-04-28","2021-04-28","2021-05-03","2021-04-28","2020-12-29","2021-03-13","2020-06-03","2020-06-03","2020-06-03","2020-12-31","2021-05-03","2021-04-23","2021-03-13","2021-04-23","2021-04-23","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-08-30","2020-12-17","2021-04-23","2021-05-03","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-05-03","2021-02-25","2021-02-25","2021-11-01","2021-11-01","2021-11-01","2021-11-11","2021-11-11"],"priorHcc":["","","",null,"",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":[["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","60505265301","TRAZODONE","50MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","-20","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","10","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","40","Select","Select",""],["","00093314505","CEPHALEXIN","250MG","-30","Select","Select",""],["","55111015330","ONDANSETRON","4MG","40","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","30","Select","Select",""],["","00228202796","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","00093314505","CEPHALEXIN ","250MG","30","Select","Select",""],["","60505265301","TRAZODONE ","50MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","40","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","20","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","10","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","40","Select","Select",""],["","59676058005","JANSSEN","COVID-19","0","Select","Select",""],["","61314030802","AZELASTINE","0.05%","6","Select","Select",""],["","61314030802","AZELASTINE ","DRO 0.0005","-6","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":""}]}]}