{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMARA CONKLIN","gend":1,"add":"203 W BAY AVE","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1971-09-25","age":"","mstatus":"","insh":"1379765*01","cliId":"","pno":"757\/373-7345","cno":"757\/373-7345","email":"","ename":"","eno":"","pphy":"NELSON, MERRILYN E DO","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/226-0247","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L82.0","L90.5","L91.8","D18.01","D22.9","D23.9","L70.0","L81.4","Z12.31","E78.5","J45.40","K21.9","J30.89","Z76.89","E78.2","R53.83","Z23.","M25.512","M25.521","G89.29","R32.","L25.5"],"date":["2020-01-31","2020-01-31","2020-01-31","2020-01-31","2020-01-31","2020-01-31","2020-01-31","2020-01-31","2021-03-09","2020-10-02","2021-08-16","2021-08-16","2021-08-16","2020-04-08","2021-08-16","2020-10-02","2020-11-06","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-07-17"],"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":[["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00173071820","FLOVENT ","44MCG","-11","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00378727253","NORETHINDRON ","0.35MG","84","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","29300024016","TOLTERODINE ","2MG","180","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","90","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","28","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","59746000106","METHYLPRED ","4MG","-30","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","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":""}]}]}