{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATTHEW   R MORRISETTE","gend":0,"add":"2210 CYPRESS AVE APT B","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1980-12-21","age":"","mstatus":"","insh":"1314936*01","cliId":"","pno":"757\/376-6398","cno":"757\/376-6398","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":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/425-7180","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","M50.30","M48.02","M54.2","M47.22","M50.11","M25.78","M54.12","D48.5","Z71.9","Z28.21","M50.10","Z01.810","Z01.812","L72.3","M50.322","M99.71","M50.323","M47.812","M96.1","G89.4","Z20.822","Z20.828","Z01.818","J43.9","Z96.82","F17.210","Z79.899","Z88.0","Z88.2"],"date":["2021-01-26","2020-09-08","2021-02-08","2020-10-15","2021-04-06","2020-11-30","2020-11-30","2020-12-31","2020-05-26","2020-05-26","2020-05-26","2020-11-30","2021-01-26","2021-01-26","2020-05-12","2020-09-08","2020-08-17","2020-09-08","2020-09-08","2020-11-04","2020-11-04","2021-02-05","2020-11-04","2020-10-27","2020-10-27","2020-10-27","2020-11-04","2020-11-04","2020-11-04","2020-11-04"],"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":[["","42192060716","BROM\/PSE\/DM ","","200","Select","Select",""],["","00603107554","CHERATUSSIN ","AC","-30","Select","Select",""],["","70710101002","OSELTAMIVIR ","75MG","10","Select","Select",""],["","00143211205","DOXYCYCL ","100MG","14","Select","Select",""],["","65162062750","TRAMADOL ","50MG","14","Select","Select",""],["","00406052201","OXYCOD\/APAP ","7.5-325","21","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","59762444002","METHYLPRED ","4MG","-21","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","42192060716","BROM\/PSE\/DM","","200","Select","Select",""],["","70710101002","OSELTAMIVIR","75MG","10","Select","Select",""],["","00603107554","CHERATUSSIN","AC","30","Select","Select",""],["","00143211205","DOXYCYCL","100MG","14","Select","Select",""],["","59762444002","METHYLPRED","4MG","-21","Select","Select",""],["","65162062750","TRAMADOL","50MG","14","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","20","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","88888888887","DMR","","1","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":""}]}]}