{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUSSELL   L POTTER","gend":0,"add":"3212 SUGAR CREEK DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1960-04-13","age":"","mstatus":"","insh":"1703172*01","cliId":"","pno":"757\/468-2488","cno":"757\/468-2488","email":"","ename":"","eno":"","pphy":"CALLAHAN, ROBERT D MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/506-8084","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.30","M54.32","F43.22","R41.89","M54.16","Z09.","J80.","Z20.828","M48.061","M51.16","M51.87","M24.28","M51.37","M47.817","Z85.820","M79.605","I10.","M54.5","M51.14","M96.1","Z48.89","J45.20","J45.31","M62.81","R06.02","Z11.59","R06.00","R07.0","R53.83","M79.10","R51.","R19.7","R63.0","R43.0","R43.2","J20.9","R05.","R50.9","K21.9","Z98.1","Z88.8","Z88.6","Z91.018","Z87.891","R01.1","G89.4","Z79.891","M47.26","M51.36","R07.9","M99.73","M51.27","M51.26","G89.29","M47.896","J02.9","M79.18","M53.3","M46.1","R10.9","K63.5","L72.3","A09.","K64.9"],"date":["2020-10-01","2020-10-01","2021-02-02","2021-02-02","2021-03-09","2020-06-23","2020-05-11","2021-11-01","2021-03-09","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2021-05-13","2020-06-02","2020-09-14","2021-01-27","2021-05-13","2021-01-12","2021-09-14","2020-02-11","2020-03-18","2020-04-30","2020-06-23","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2021-03-09","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2021-01-27","2020-03-05","2020-01-16","2020-06-02","2021-05-13","2020-05-19","2020-06-02","2020-06-02","2020-06-02","2021-05-13","2020-03-05","2020-05-01","2021-05-13","2021-05-13","2021-05-13","2021-08-10","2021-08-31","2021-08-31","2021-11-01","2021-10-27"],"priorHcc":["","","","","","","",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":[["","70010075401","METHOCARBAM","500MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","68180069906","TRAMADOL","300MG ER","30","Select","Select",""],["","43598029290","PREGABALIN","50MG","90","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","120","Select","Select",""],["","65862020299","LOSARTAN","50MG","-90","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65162010150","GABAPENTIN","100MG","90","Select","Select",""],["","24510012010","XTAMPZA","18MG","60","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","30","Select","Select",""],["","59011042020","OXYCONTIN","20MG CR","60","Select","Select",""],["","00591544305","PREDNISONE","20MG","21","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","1","Select","Select",""],["","67877025520","CEPHALEXIN","750MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","120","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","-60","Select","Select",""],["","68180069906","TRAMADOL ","300MG ER","30","Select","Select",""],["","65862020299","LOSARTAN ","50MG","90","Select","Select",""],["","43598029290","PREGABALIN ","50MG","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00591544305","PREDNISONE ","20MG","21","Select","Select",""],["","08373747800","OPTICHAMBER ","DIAMOND","1","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","90","Select","Select",""],["","45802005535","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","67877025520","CEPHALEXIN ","750MG","-14","Select","Select",""],["","59011042010","OXYCONTIN ","20MG CR","60","Select","Select",""],["","24510012010","XTAMPZA ","18MG","60","Select","Select",""],["","00037682210","PROCTOFOAM","HC 1%","10","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","00037682210","PROCTOFOAM ","AER HC 1%","-10","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","6","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":""}]}]}