{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AIMEE   N ALARIE","gend":1,"add":"528 WINDSOR GATE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1978-11-18","age":"","mstatus":"","insh":"1415338*01","cliId":"","pno":"541\/441-0262","cno":"541\/441-0262","email":"","ename":"","eno":"","pphy":"ROBLEDO, ELIZABETH 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\/473-0666","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":["Z20.828","R51.9","Z23.","R09.81","G89.29","R51.","R00.0","R42.","Z00.00","E78.2","J45.20","F33.42","J30.89","E66.09","Z12.39","Z76.0","Z68.32","G44.209","Z88.7","Z91.018","Z91.048","R11.0","Z12.31","Z01.419","Z30.41","J30.2","S63.691A"],"date":["2020-08-15","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-08-05","2020-05-07","2020-05-07","2020-08-05","2020-08-11","2020-08-05","2021-07-14","2020-08-05","2021-07-14","2021-11-09","2020-08-05","2020-08-11","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2021-09-17","2021-11-09","2020-09-16","2021-07-14","2021-07-01"],"priorHcc":["","","","","","","","","","","","","","",null,"","","","","","","","",null,"","",""]}},{"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":[["","68382009706","PAROXETINE","10MG","30","Select","Select",""],["","51862056406","LOW-OGESTREL","","-112","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","90","Select","Select",""],["","31722072610","MONTELUKAST","10MG","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00173068220","VENTOLIN","","-18","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","51862056406","LOW-OGESTREL ","","84","Select","Select",""],["","68382009706","PAROXETINE ","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","59267100002","PFIZER ","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":""}]}]}