{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   P CARTER","gend":1,"add":"2021 GREY FOX LN","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1978-04-06","age":"","mstatus":"","insh":"1670153*02","cliId":"","pno":"757\/689-1592","cno":"757\/689-1592","email":"","ename":"","eno":"","pphy":"MENAWAT, SUNIL MD","ppno":"757\/261-5910","pcpadd":"850 KEMPSVILLE RD STE 200A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Kempsville","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/613-1286","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/466-1611","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.3","Z20.2","Z01.419","Z12.31","R51.9","M54.2","I15.8","R10.2","R11.2","N80.0","D25.9","Z84.1","Z82.0","Z91.040","Z88.5","Z88.2","Z88.0","Z91.013","R35.0","K64.4","K58.1","Z12.4","N94.6","N93.9","M70.62","M70.61","M54.5","N60.02","R92.8","M54.50","Z30.41","Z13.31","N64.89"],"date":["2020-02-13","2020-02-13","2021-10-18","2021-10-26","2021-04-13","2021-10-12","2021-04-13","2020-01-12","2020-01-12","2020-02-13","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-08-26","2020-08-26","2020-09-18","2020-02-13","2020-02-13","2020-11-03","2020-11-03","2021-09-30","2021-11-02","2021-11-02","2021-10-12","2021-10-18","2021-10-18","2021-11-02"],"priorHcc":["","",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":[["","16571020150","DICLOFENAC ","75MG DR","20","Select","Select",""],["","68462013281","NORETH\/ETHIN ","20-Jan","-84","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00456120230","LINZESS ","290MCG","30","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","20","Select","Select",""],["","68462013281","NORETH\/ETHIN","Jan-20","-84","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00456120230","LINZESS","290MCG","-30","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","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":""}]}]}