{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLEY   S HENDERSON","gend":0,"add":"808 SAINT GEORGE CT","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1974-06-06","age":"","mstatus":"","insh":"1597958*01","cliId":"","pno":"757\/270-9349","cno":"757\/270-9349","email":"","ename":"","eno":"","pphy":"PALTING, JOHN KENNETH MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"452-3113","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9171","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K57.93","R91.1","B37.0","L40.0","L81.2","D22.5","L57.0","K57.32","D72.829","I10.","E79.0","E78.1","K21.9","K76.0","R63.5","E78.6","Z87.19","J98.01","K14.8","R10.32"],"date":["2021-02-01","2021-04-19","2021-06-23","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-02-01","2021-02-01","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-02-01"],"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":[["","68382050010","OMEPRAZOLE ","40MG","-90","Select","Select",""],["","65862020399","LOSARTAN ","100MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","57237004105","PENICILLN ","500MG","30","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","57237000630","FLUCONAZOLE ","200MG","14","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","-90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","65862020399","LOSARTAN","100MG","90","Select","Select",""],["","57237004105","PENICILLN","500MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","57237000630","FLUCONAZOLE","200MG","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","",""],["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":""}]}]}