{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY KELLAM","gend":0,"add":"407 W LITTLE CREEK ROAD","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1987-03-08","age":"","mstatus":"","insh":"1466328*01","cliId":"","pno":"757\/377-6754","cno":"757\/377-6754","email":"","ename":"","eno":"","pphy":"MPOY KANYINDA, JEAN MARIE K MD","ppno":"757\/388-9925","pcpadd":"7401 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/377-6754","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/965-8519","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","I10.","G47.30","Z21.","Z88.2","Z91.018","R50.9","R07.9","R06.00","L24.9","M75.42","Z88.9","J45.20","R76.8","M25.50","L20.84","E78.5","R19.7","M25.511","S43.431A","M50.022","M50.023","R20.0","R20.2","M79.642","M79.641","M79.672","M79.671","G89.29","R07.89","Z91.011","R79.89","I42.2","M25.542","M25.541","M25.572","M25.571","K52.9","L30.1"],"date":["2020-02-09","2021-08-10","2020-05-19","2021-08-10","2020-05-19","2020-02-09","2020-02-09","2020-05-27","2020-06-19","2020-05-27","2021-02-04","2021-02-04","2021-08-10","2021-03-24","2021-03-24","2020-11-06","2021-08-10","2021-04-14","2021-03-02","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-01-12","2020-05-19","2020-05-19","2021-01-22","2021-08-10","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-07-19","2021-11-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","61958110101","COMPLERA","","-30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","50111033301","METRONIDAZOL","250MG","-15","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","30","Select","Select",""],["","68682011320","MESALAMINE","0.375GM","360","Select","Select",""],["","45802006436","TRIAMCINOLON","0.10%","-80","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","-75","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","51672125903","CLOBETASOL","0.05%","60","Select","Select",""],["","00955104590","IRBESAR\/HCTZ","150-12.5","90","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68382079201","ACYCLOVIR","800MG","35","Select","Select",""],["","46581067005","SALONPAS","PAIN REL","15","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","51862094205","DIAZEPAM","5MG","1","Select","Select",""],["","17478076306","DRONABINOL","10MG","60","Select","Select",""],["","61958110101","COMPLERA ","","-30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","-16","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","50111033301","METRONIDAZOL ","250MG","15","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","-90","Select","Select",""],["","68682011320","MESALAMINE ","0.375GM","-360","Select","Select",""],["","46581067005","SALONPAS ","PAIN REL","15","Select","Select",""],["","45802006436","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","68382079201","ACYCLOVIR ","800MG","35","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","51672125903","CLOBETASOL ","0.05%","60","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","-75","Select","Select",""],["","17478076306","DRONABINOL ","10MG","60","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","33342005707","IRBESAR\/HCTZ ","150-12.5","90","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","-30","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","1","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","28","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","28","Select","Select",""],["","00472038145","BETAMETH ","OIN 0.0005","45","Select","Select",""],["","55724021121","EUCRISA ","OIN 0.02","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","",""],["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":""}]}]}