{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELODY   A ZEILER","gend":1,"add":"4184 RAINBOW DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1987-10-02","age":"","mstatus":"","insh":"1671736*02","cliId":"","pno":"757\/553-2182","cno":"757\/553-2182","email":"","ename":"","eno":"","pphy":"WOODS, DAVID W MD","ppno":"757\/363-6800","pcpadd":"#100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":101283,"pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9029","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E28.2","R10.2","Z30.011","N92.0","Z87.42","Z71.9","D25.9","N80.9","Z20.828","F41.9","F41.0","F32.1","K21.9","G44.89","E66.01","G47.00","E78.2","J30.1","Z30.019","R03.0","J20.9","R73.9","L30.9","H69.83","F32.5","N89.8","N80.3"],"date":["2020-07-31","2020-11-18","2020-10-29","2021-06-14","2021-06-14","2021-06-14","2020-11-18","2021-09-03","2020-12-31","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2021-11-15","2021-11-19","2020-06-18","2021-11-19","2021-11-15","2021-09-03","2021-11-19","2021-10-04","2021-11-19","2021-10-25","2021-11-15","2021-11-15","2021-11-12","2021-11-12"],"priorHcc":["","","","","","","","","","","","","",null,null,"",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":[["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","16729003415","LETROZOLE","2.5MG","5","Select","Select",""],["","68180088673","NIKKI","3-0.02MG","84","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","30","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","30","Select","Select",""],["","68382075810","METFORMIN","500MG","180","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","69918030130","TRANEX","650MG","30","Select","Select",""],["","55111029336","SUMATRIPTAN","100MG","9","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","30","Select","Select",""],["","55111029336","SUMATRIPTAN ","100MG","9","Select","Select",""],["","68382075810","METFORMIN ","500MG","60","Select","Select",""],["","16729003415","LETROZOLE ","2.5MG","5","Select","Select",""],["","68180088673","NIKKI ","3-0.02MG","84","Select","Select",""],["","69918030130","TRANEX ","650MG","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","68180016011","AZITHROMYCIN","250MG","6","Select","Select",""],["","00378334053","XULANE","150-35","3","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00074003828","ORILISSA ","TAB 150MG","-30","Select","Select",""],["","00378334053","XULANE ","DIS 150-35","3","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","68180016011","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","3","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":""}]}]}