{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN   A PADEN","gend":0,"add":"2356 NORTH WOLFSNARE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1958-04-15","age":"","mstatus":"","insh":"1641884*01","cliId":"","pno":"757\/376-8784","cno":"757\/376-8784","email":"","ename":"","eno":"","pphy":"HAGGERTY, MARK DO","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH BLVD","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":"757\/410-3175","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/226-0247","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I87.312","J33.0","J30.1","D48.5","L30.9","B35.4","Z71.9","L57.8","L82.1","Z28.21","D10.39","J30.89","E11.40","S90.32XA","E11.8","E11.65","Z00.00","R68.89","I87.2","I73.9","I25.10","E78.2","I10.","E11.9","E78.5","Z12.5","L97.229","J30.81","L97.821","S90.32XD","J32.9","J33.9","J30.9","J31.0","I49.3","R06.02","R06.2","R05.","H25.13","H40.003","Z79.84","G47.33","Z12.11","I83.029","M46.1","K63.5","I83.892","Z82.49","I11.9","I25.2","G47.30","K21.9","F41.9","Z87.448","Z79.82","Z79.899","Z79.891","L81.4","K06.8","Z86.010","D12.2","D12.3","K57.30","D12.6","K63.89","Z86.018"],"date":["2020-02-04","2021-01-08","2020-02-21","2021-07-20","2020-02-21","2020-06-04","2020-06-04","2021-07-20","2021-07-20","2020-06-04","2021-04-21","2020-03-09","2020-02-04","2020-02-04","2021-08-23","2021-08-23","2021-05-14","2021-05-19","2021-07-20","2020-01-06","2021-04-08","2021-04-01","2021-08-23","2021-04-08","2021-08-23","2020-09-28","2020-01-06","2020-02-21","2020-02-04","2020-02-04","2020-02-13","2020-02-13","2021-08-23","2020-02-13","2021-04-08","2021-04-08","2021-08-23","2020-12-15","2020-01-27","2020-01-27","2021-04-08","2021-08-05","2020-09-28","2020-09-28","2020-09-28","2021-10-21","2020-09-28","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-07-20","2021-05-14","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-10-21"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","59310021012","QNASL","80MCG","9","Select","Select",""],["","59746017306","PREDNISONE","10MG","75","Select","Select",""],["","68180015301","DESLORATADIN","5MG","30","Select","Select",""],["","69238115403","EZETIMIBE","10MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","90","Select","Select",""],["","00597015390","JARDIANCE","25MG","-90","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","50742061501","METOPROL","25MG ER","90","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","16714069301","FLUCONAZOLE","200MG","4","Select","Select",""],["","42806031505","METFORMIN","1000MG","180","Select","Select",""],["","67877019905","AMLODIPINE","10MG","90","Select","Select",""],["","68682085060","LULICONAZOLE","1%","60","Select","Select",""],["","62332013330","OLMESA","40MG","90","Select","Select",""],["","11822576460","RA PEN NEEDL","31GX3\/16","-100","Select","Select",""],["","00378700701","KETOCONAZOLE","2%","100","Select","Select",""],["","69097031887","BUDESONIDE","0.25MG\/2","-60","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","27808015801","ROSUVASTATIN","40MG","90","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","45802005536","TRIAMCINOLON","0.10%","80","Select","Select",""],["","00173068220","VENTOLIN","","-18","Select","Select",""],["","65162083366","DICLOFENAC","1%","400","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","5","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","30","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","-9","Select","Select",""],["","59746017306","PREDNISONE ","10MG","75","Select","Select",""],["","68180015301","DESLORATADIN ","5MG","30","Select","Select",""],["","59310021012","QNASL ","80MCG","-9","Select","Select",""],["","42806031505","METFORMIN ","1000MG","180","Select","Select",""],["","50742061501","METOPROL ","25MG ER","90","Select","Select",""],["","68682085060","LULICONAZOLE ","1%","60","Select","Select",""],["","31722070190","LOSARTAN ","50MG","90","Select","Select",""],["","45802005536","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","67877019905","AMLODIPINE ","10MG","90","Select","Select",""],["","27808015801","ROSUVASTATIN ","40MG","90","Select","Select",""],["","62332013330","OLMESA ","40MG","90","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","90","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","11822576460","RA  PEN NEEDL","31GX3\/16","100","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","00597015330","JARDIANCE ","25MG","-90","Select","Select",""],["","45802053233","KETOCONAZOLE ","2%","100","Select","Select",""],["","16714069301","FLUCONAZOLE ","200MG","4","Select","Select",""],["","69097031887","BUDESONIDE ","0.25MG\/2","60","Select","Select",""],["","65162083366","DICLOFENAC ","1%","400","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","00173068220","VENTOLIN ","","-18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","5","Select","Select",""],["","08489831010","PEN NEEDLES","31GX5MM","100","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","08489831010","PEN  NEEDLES  ","MIS 31GX5MM","100","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}