{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN   CATHERINE HARTMANN","gend":1,"add":"910 MEDITERRANEAN AVE APT 302","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1969-07-23","age":"","mstatus":"","insh":"1782619*01","cliId":"","pno":"757\/449-7330","cno":"757\/449-7330","email":"","ename":"","eno":"","pphy":"BAKHSHI, RAJA M MD","ppno":"757\/395-6900","pcpadd":"984B LASKIN ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":117346,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/449-7330","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/425-7180","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","R06.02","R00.0","F41.9","I47.1","I47.2","M77.11","I10.","G47.00","N95.1","Z13.220","Z01.419","R07.9","Z87.891","Z88.1","R94.31","R06.2","Z12.31","H16.223","Z20.822","M75.21","M25.511"],"date":["2020-09-01","2020-07-28","2020-08-28","2021-06-25","2020-11-10","2020-09-30","2021-09-29","2021-06-25","2021-06-25","2021-08-19","2020-08-14","2020-04-30","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-08-28","2021-03-11","2020-02-06","2021-09-27","2021-11-11","2021-11-11"],"priorHcc":["","","","","","",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":[["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","68382031910","TRAMADOL","50MG","15","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","6","Select","Select",""],["","13668001105","CITALOPRAM","40MG","90","Select","Select",""],["","13668000705","ZOLPIDEM","5MG","15","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","68682099798","DILTIAZEM","240MG ER","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","75987001003","DUEXIS","800-26.6","90","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","6","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","75834010901","CHLORTHALID","25MG","90","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","50111043301","TRAZODONE ","50MG","90","Select","Select",""],["","13668000705","ZOLPIDEM ","5MG","15","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","68382031910","TRAMADOL ","50MG","15","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","6","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","6","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","68682099798","DILTIAZEM ","240MG ER","30","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","75987001003","DUEXIS ","800-26.6","90","Select","Select",""],["","75834010901","CHLORTHALID ","25MG","90","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20","Select","Select",""],["","68025008330","DIVIGEL ","0.75MG","24","Select","Select",""],["","68025008330","DIVIGEL","0.75MG","24","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","15","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","15","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":""}]}]}