{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   L DOYLE","gend":1,"add":"8140 DEERFIELD RD","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1965-07-08","pno":"757\/708-2109","cno":"757\/708-2109","email":"","pphy":"JAVIER, ROSA M MD","ppno":"","pcpadd":"5460 WESLEYAN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Wesleyan","insh":"1474239*01","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"460-1101","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/995-7373","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z08.","Z85.828","L63.8","B35.3","R63.5","Z68.34","R55.","R51.9","M54.2","I10.","G89.29","J09.X2","Z00.00","R73.01","I83.813","R39.15","Z12.39","R59.0","J39.2","Z12.31","Z12.11","T40.7X1A","H53.8","R40.0","Z88.8","Z11.52","M54.41","R21.","M54.12","I83.899","E66.9","L57.0","I78.1","E04.2","R00.2","R42.","M79.605","Z68.32","R03.1","R23.2","R29.818","Z11.59","R73.03","E88.81","E55.9","Z68.33","Z01.419","N95.2","N95.1","R06.02","R53.83"],"date":["2020-10-15","2020-10-15","2020-10-15","2020-10-15","2021-10-14","2020-10-23","2021-10-08","2021-10-29","2021-09-13","2021-10-08","2021-09-13","2020-02-02","2021-06-11","2021-06-11","2020-11-11","2020-06-26","2021-10-08","2020-01-28","2020-01-28","2020-03-11","2021-08-30","2021-09-10","2021-09-10","2021-09-10","2021-09-29","2021-09-23","2020-06-26","2021-08-02","2021-06-11","2020-06-26","2021-10-25","2020-09-09","2020-11-11","2021-10-14","2021-10-08","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-10-08","2021-10-08","2021-09-23","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-11-08","2021-11-08","2021-11-08","2021-10-05","2021-10-05"],"priorHcc":["","","","",null,"",null,null,"",null,"","","","","","",null,"","","",null,"","","",null,"","","","","",null,"","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","13668015730","TELMISARTAN","40MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","90","Select","Select",""],["","68180067711","OSELTAMIVIR","75MG","10","Select","Select",""],["","50428199229","SOLUBLE","THERAPY","180","Select","Select",""],["","68462053253","CLOBETASOL","0.05%","50","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","69097085902","TERBINAFINE","250MG","14","Select","Select",""],["","58160081912","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","42806016005","HYDROXYZ","25MG","60","Select","Select",""],["","67877056110","METFORMIN","500MG","180","Select","Select",""],["","00378064205","PREDNISONE","20MG","12","Select","Select",""],["","13668015730","TELMISARTAN ","TAB 40MG","90","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","-6","Select","Select",""],["","68180067711","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","68462053253","CLOBETASOL ","SOL 0.0005","-50","Select","Select",""],["","50428199229","SOLUBLE ","TAB THERAPY","60","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","69097085902","TERBINAFINE ","TAB 250MG","14","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0","Select","Select",""],["","58160081912","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","67877056110","METFORMIN ","TAB 500MG","-180","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","12","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","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":""}]}]}