{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BILL   U BERRY","gend":0,"add":"252 CAPOT ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1959-02-09","age":"","mstatus":"","insh":"1705930*01","cliId":"","pno":"757\/618-6795","cno":"757\/618-6795","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":"","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":["Z00.00","Z12.5","E78.5","E11.9","R73.03","R94.5","K21.9","N18.2","I25.10","R10.32","K57.92","R73.9","I10.","R60.0","E11.69","E11.65","I73.9","M1A.09X0","K63.5","H93.13","N20.0","D48.5","Z71.9","Z12.11","Z23.","E11.59","M10.00","I15.2"],"date":["2021-03-31","2021-03-31","2021-10-11","2021-10-11","2020-06-19","2021-04-08","2021-04-08","2020-06-16","2021-10-11","2021-01-05","2021-01-05","2020-01-10","2021-04-08","2020-01-17","2021-10-11","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2020-01-29","2021-07-13","2021-07-13","2021-08-30","2021-10-11","2021-10-11","2021-10-11","2021-10-11"],"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":[["","00832532411","POT CL MICRO","10MEQ ER","-90","Select","Select",""],["","66758017092","KLOR-CON","10MEQ ER","-90","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","68645055854","LISINOP\/HCTZ","20-25MG","90","Select","Select",""],["","68645059090","CLOPIDOGREL","75MG","90","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","90","Select","Select",""],["","16714068303","SIMVASTATIN","20MG","90","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","90","Select","Select",""],["","00173068220","VENTOLIN","","-18","Select","Select",""],["","16714004211","ALLOPURINOL","300MG","90","Select","Select",""],["","67877041301","METFORMIN","500MG ER","60","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","16571041210","CIPROFLOXACN","500MG","20","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","90","Select","Select",""],["","00832532411","POT  CL MICRO","10MEQ ER","-90","Select","Select",""],["","66758017092","KLOR-CON ","10MEQ ER","-90","Select","Select",""],["","68645059090","CLOPIDOGREL ","75MG","90","Select","Select",""],["","16714068303","SIMVASTATIN ","20MG","90","Select","Select",""],["","16714004211","ALLOPURINOL ","300MG","90","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","13","Select","Select",""],["","68645055854","LISINOP\/HCTZ ","20-25MG","90","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","68645058259","METFORMIN ","500MG","60","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","16571041210","CIPROFLOXACN ","500MG","20","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","68645057290","GLIMEPIRIDE","2MG","90","Select","Select",""],["","68645057290","GLIMEPIRIDE ","TAB 2MG","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":[[["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":""}]}]}