{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATHAN PROPST","gend":0,"add":"5532 BAYSIDE ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1966-03-30","age":"","mstatus":"","insh":"1719993*01","cliId":"","pno":"757\/717-6880","cno":"757\/717-6880","email":"","ename":"","eno":"","pphy":"JAVIER, ROSA M MD","ppno":"757\/395-1900","pcpadd":"5460 WESLEYAN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Wesleyan","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/717-6880, ","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":["G47.33","I48.0","I25.10","I20.8","E78.5","R43.0","J40.","Z20.828","R05.","M79.10","R50.9","R06.02","B34.9","L57.8","D18.01","L82.1","L57.0","Z12.11","Z12.83","I25.118"],"date":["2021-02-22","2021-09-20","2021-03-08","2021-09-20","2021-09-20","2021-03-08","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-10-03","2021-04-09","2021-04-09","2021-04-09","2020-05-20","2020-06-19","2021-04-09","2021-09-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","55111019690","CLOPIDOGREL","75MG","30","Select","Select",""],["","27808015501","ROSUVASTATIN","5MG","30","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","25","Select","Select",""],["","11822316910","RA","81MG EC","30","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00121077504","GG\/CODEINE","100-10\/5","118","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","15","Select","Select",""],["","65162046650","IBUPROFEN","800MG","20","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","8","Select","Select",""],["","55111019690","CLOPIDOGREL ","75MG","30","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","27808015501","ROSUVASTATIN ","5MG","30","Select","Select",""],["","11822316910","RA ","81MG EC","30","Select","Select",""],["","00121077504","GG\/CODEINE ","100-10\/5","118","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","28","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","8","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","20","Select","Select",""],["","00603533932","PREDNISONE ","20MG","21","Select","Select",""],["","10135017301","ASPIRIN","81MG EC","90","Select","Select",""],["","58160088752","FLUARIX","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","",""],["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":""}]}]}