{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM VICK JR","gend":0,"add":"5504 WESTMORELAND DR","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1970-12-28","age":"","mstatus":"","insh":"1380557*01","cliId":"","pno":"757\/592-1222","cno":"757\/592-1222","email":"","ename":"","eno":"","pphy":"WATKINS, ROGER A MD","ppno":"757\/259-6770","pcpadd":"SUITE 102 4374 NEWTOWN AVE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":130406,"pcpname":"SMG - Sentara Internal Medicine Physicians - New Town","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/229-2677","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/259-6794","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.810","M25.562","S83.232A","M17.12","M94.262","M25.462","M23.42","L30.9","L73.9","B35.3","L81.2","Z01.818","G47.33","F32.0","M23.332","M22.42","S83.242A","R51.","R50.9","R09.81","Z01.84","M23.232","M25.522","Z00.00","R73.9","M25.561","E66.09","Z68.39","G89.29"],"date":["2020-08-14","2021-08-13","2020-07-27","2020-07-27","2020-08-17","2020-07-27","2020-07-27","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2020-08-14","2020-08-14","2021-08-13","2020-08-17","2020-08-17","2020-08-17","2020-02-24","2020-02-24","2020-02-24","2020-05-26","2020-08-17","2020-02-04","2021-08-13","2021-08-10","2021-08-13","2021-08-13","2021-08-13","2021-08-13"],"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":[["","00054040022","DESVENLAFAX ","50MG ER","30","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","51672129803","KETOCONAZOLE ","2%","60","Select","Select",""],["","50111043302","TRAZODONE ","50MG","45","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":""}]}]}