{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   F MAHONEY JR","gend":0,"add":"572 OLD POST RD","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1957-09-24","age":"","mstatus":"","insh":"1349222*01","cliId":"","pno":"757\/486-2103","cno":"757\/486-2103","email":"","ename":"","eno":"","pphy":"CALLAHAN, ROBERT D MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/651-6580, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9004","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z85.46","G57.13","G60.3","R25.2","H90.3","H93.13","J34.2","R52.","Z00.00","Z23.","M75.42","M65.352","H91.93","K21.9","K75.81","Z20.828","L30.9","B35.6","R53.83","M79.10","R19.7","M65.342","M19.042","M19.041","J02.9","L43.9","Z71.9"],"date":["2020-09-11","2021-01-13","2021-01-13","2021-01-13","2020-10-13","2020-10-13","2020-10-13","2020-10-16","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2021-02-08","2021-03-16","2021-03-16","2020-05-30","2020-05-30","2020-05-30","2020-10-16","2020-10-16","2020-10-16","2021-02-08","2021-07-27","2021-07-27"],"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":[["","68462019005","NAPROXEN","500MG","180","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","66993094748","CLOCORTOLONE","0.10%","-45","Select","Select",""],["","68462029052","AUG","0.05%","50","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00472037915","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","30","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","30","Select","Select",""],["","00472037915","CLOTRIM\/BETA ","DIPROP","15","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","66993094748","CLOCORTOLONE ","0.10%","-45","Select","Select",""],["","68462029017","AUG ","0.05%","30","Select","Select",""],["","55724021121","EUCRISA ","2%","60","Select","Select",""],["","55724021121","EUCRISA","2%","60","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":""}]}]}