{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAWN   T BUTELA","gend":0,"add":"4100 CHURCH POINT RD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1969-07-03","age":"","mstatus":"","insh":"1546402*01","cliId":"","pno":"757\/460-3679","cno":"757\/460-3679","email":"","ename":"","eno":"","pphy":"LOCK, RACHEL DO","ppno":"757\/395-2500","pcpadd":"1024 FIRST COLONIAL RD STE 102","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117368,"pcpname":"SMG - Sentara Family Medicine Physicians - First Colonial","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"818\/636-6017","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9700","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G90.9","G62.9","Z00.00","Z23.","I10.","Z13.6","D49.9","I48.0","G13.0","G90.8","G98.8","C80.1","M47.814","M47.815","M54.6","Z12.11","K63.5","D12.6","Z12.83","Z20.828","D12.2","K57.30","I25.10"],"date":["2021-11-02","2021-11-02","2021-05-11","2021-09-14","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-06-29","2020-01-09","2020-01-09","2020-03-05","2020-03-05","2020-03-05","2020-03-12","2020-03-12","2020-03-12","2020-02-10","2021-03-29","2020-03-12","2020-03-12","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":[["","68382002310","ATENOLOL","50MG","90","Select","Select",""],["","00054001225","FLECAINIDE","150MG","180","Select","Select",""],["","00378012701","PINDOLOL","10MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","00832105410","BACLOFEN","10MG","360","Select","Select",""],["","60505025203","TIZANIDINE","4MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","00054001225","FLECAINIDE ","150MG","180","Select","Select",""],["","68382002310","ATENOLOL ","50MG","90","Select","Select",""],["","00378012701","PINDOLOL ","10MG","90","Select","Select",""],["","00832105410","BACLOFEN ","10MG","120","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","-30","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","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":""}]}]}