{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXANDRA   L RUNALDUE","gend":1,"add":"3908 W STRATFORD RD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1961-11-16","age":"","mstatus":"","insh":"1403591*01","cliId":"","pno":"757\/288-3333","cno":"757\/288-3333","email":"","ename":"","eno":"","pphy":"BADEMIAN, ROBERT L MD","ppno":"757\/261-5910","pcpadd":"SUITE 200A 850 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Kempsville","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L02.414","Z03.818","Z11.59","F41.9","F51.04","F32.9","S05.01XA","Z01.419","Z12.39","Z12.4"],"date":["2020-02-04","2020-07-13","2020-07-13","2021-07-29","2021-07-29","2021-07-29","2021-05-06","2021-07-29","2021-07-29","2021-07-29"],"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":[["","65862019301","FLUOXETINE","20MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","90","Select","Select",""],["","55111016330","OLANZAPINE","2.5MG","30","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","28","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","14","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","-5","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","65862019301","FLUOXETINE ","20MG","30","Select","Select",""],["","55111016330","OLANZAPINE ","2.5MG","30","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","28","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","90","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","14","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","69315030805","CIPROFLOXACN ","0.3% OP","5","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":""}]}]}