{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   M FREEMAN","gend":1,"add":"121 SAWMILL ROAD","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1961-11-24","age":"","mstatus":"","insh":"1687617*02","cliId":"","pno":"757\/784-7439","cno":"757\/784-7439","email":"","ename":"","eno":"","pphy":"JAVERNICK, MICHAEL J MD","ppno":"757\/345-4600","pcpadd":"STE 450 400 SENTARA CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":130627,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/221-0030","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-4601","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N64.59","N63.0","M51.16","R10.2","N63.11","R92.8","M50.10","M54.12","Z00.00","E78.5","D72.819","K64.4","Z86.010","N64.89","Z98.890","Z01.419","H40.013","H04.123","H25.13","H43.812","R29.898","E55.9","F33.9","Z28.21","H18.543","M54.2","M62.81","N30.10","H52.13","H52.203","H52.4","Z12.11"],"date":["2020-06-29","2020-06-29","2021-05-06","2021-08-12","2021-03-31","2021-03-31","2021-05-05","2021-01-18","2021-03-12","2021-03-15","2021-04-15","2020-09-18","2020-09-18","2020-06-29","2020-06-29","2021-03-15","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-01-18","2021-03-15","2021-03-15","2021-03-15","2021-10-26","2021-06-02","2021-06-02","2021-08-12","2021-10-26","2021-10-26","2021-10-26","2021-08-30"],"priorHcc":["","","","","","","","","","","","","","","","",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":[["","42494030124","HYDROCORT","25MG","30","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","16714066101","GABAPENTIN","100MG","90","Select","Select",""],["","42494030124","HYDROCORT ","25MG","-30","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","16714066101","GABAPENTIN ","100MG","90","Select","Select",""],["","50458009801","ELMIRON ","100MG","-90","Select","Select",""],["","50458009801","ELMIRON","100MG","-90","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","",""],["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":""}]}]}