{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY   S BAXTER","gend":1,"add":"8147 DELLWOOD RD","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1976-03-24","pno":"757\/313-1045","cno":"757\/313-1045","email":"","pphy":"GATA JR, RENATO G MD","ppno":"","pcpadd":"5460 WESLEYAN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Wesleyan","insh":"1627356*01","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/618-0672","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":["M25.562","Z01.419","M76.32","M70.52","N60.01","N64.89","E88.81","E03.9","L98.9","G89.29","D22.9","D18.00","Z12.83","Z71.9","Z28.21","E78.00","E55.9","M22.2X2","M25.50","Z00.00","Z12.31","E28.2","M79.10"],"date":["2020-03-03","2021-09-17","2020-02-12","2020-02-12","2020-05-27","2020-05-27","2021-09-22","2021-09-22","2020-01-06","2020-01-06","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2021-09-22","2020-09-16","2020-01-09","2021-06-14","2021-01-08","2020-11-30","2021-09-22","2021-06-14"],"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":[["","69452015120","VITAMIN","50000UNT","24","Select","Select",""],["","31722088290","ROSUVASTATIN","5MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","69097082112","GEMFIBROZIL","600MG","180","Select","Select",""],["","65862090901","CELECOXIB","200MG","30","Select","Select",""],["","65862076990","FENOFIBRATE","145MG","-90","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","24","Select","Select",""],["","31722088290","ROSUVASTATIN ","TAB 5MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","69097082112","GEMFIBROZIL ","TAB 600MG","-180","Select","Select",""],["","65862090901","CELECOXIB ","CAP 200MG","30","Select","Select",""],["","65862076990","FENOFIBRATE ","TAB 145MG","-90","Select","Select",""],["","59267100001","PFIZER ","INJ 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":""}]}]}