{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KOREY   ANN THOMPSON","gend":1,"add":"5121 BARDITH CIR","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1995-09-29","age":"","mstatus":"","insh":"1789719*01","cliId":"","pno":"757\/701-3021","cno":"757\/701-3021","email":"","ename":"","eno":"","pphy":"STEWART, LEAH A NP","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"ACA","lob":"Individual","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":["M79.89","M54.2","F10.129","R20.2","R20.0","F10.239","F41.1","F12.20","F10.20","N39.0","F10.24","J30.2","F10.280","F17.210","S61.411A","T24.232A","R51.","F17.200","E55.9","N77.1","R30.0","Z12.4","R89.6","F14.20","Z01.419","Z30.017","T24.202D","F10.120","R40.4","R41.0","R51.9","M79.603","M54.12","S19.9XXA","T14.90XA","J30.9","S61.011A","F41.9","F33.1","T24.039A","T24.032A","S60.221A","G25.1","M50.20","Z79.899","R51.0","Z20.2","T24.202A","S06.0X1A","S13.4XXA","S23.3XXA","R41.82","Z20.828","R05.","Z11.3","R82.998"],"date":["2020-07-02","2021-05-03","2020-12-01","2020-12-01","2020-12-01","2021-05-14","2021-05-14","2021-05-14","2021-11-03","2021-05-04","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2020-07-18","2020-07-18","2020-07-18","2020-11-04","2021-05-04","2021-05-04","2021-05-17","2021-05-19","2021-06-04","2020-07-30","2021-05-17","2021-06-25","2020-07-22","2020-11-25","2020-11-25","2020-11-25","2021-08-16","2020-11-25","2020-11-25","2020-11-25","2020-11-25","2021-04-26","2020-07-14","2021-10-20","2021-10-20","2020-06-26","2020-07-02","2020-07-02","2020-07-22","2020-11-04","2020-11-04","2021-04-25","2021-05-17","2020-07-02","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2021-08-16","2021-08-16","2021-11-16","2021-11-16"],"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":[["","53746010901","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","51991074690","DULOXETINE","20MG","28","Select","Select",""],["","70010075401","METHOCARBAM","500MG","-40","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","28","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","28","Select","Select",""],["","68382056928","ACAMPRO","333MG","84","Select","Select",""],["","51672206200","3","2%","21","Select","Select",""],["","16729020201","BUSPIRONE","10MG","42","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","51862094305","DIAZEPAM","10MG","90","Select","Select",""],["","75834002012","VITAMIN","50000UNT","8","Select","Select",""],["","55111012601","CIPROFLOXACN","250MG","14","Select","Select",""],["","51293081001","PHENAZOPYRID","100MG","6","Select","Select",""],["","00406117003","NALTREXONE","50MG","-30","Select","Select",""],["","00093816601","QUETIAPINE","50MG","-14","Select","Select",""],["","14539067501","HYDROXYZ","50MG","56","Select","Select",""],["","59651017401","DOXEPIN","25MG","14","Select","Select",""],["","60505265301","TRAZODONE","50MG","14","Select","Select",""],["","68180012201","CEPHALEXIN ","500MG","28","Select","Select",""],["","16729020201","BUSPIRONE ","10MG","42","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","14539067501","HYDROXYZ ","50MG","56","Select","Select",""],["","00093816601","QUETIAPINE ","50MG","-14","Select","Select",""],["","51991074690","DULOXETINE ","20MG","28","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","40","Select","Select",""],["","59651017401","DOXEPIN ","25MG","14","Select","Select",""],["","68462043518","ACAMPRO ","333MG","-84","Select","Select",""],["","68462010805","TOPIRAMATE ","25MG","60","Select","Select",""],["","51862094305","DIAZEPAM ","10MG","90","Select","Select",""],["","75834002012","VITAMIN ","50000UNT","4","Select","Select",""],["","51293081001","PHENAZOPYRID ","100MG","6","Select","Select",""],["","00406117003","NALTREXONE ","50MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","55111012601","CIPROFLOXACN ","250MG","14","Select","Select",""],["","60505265301","TRAZODONE ","50MG","14","Select","Select",""],["","80777027315","MODERNA ","COVID-19","0","Select","Select",""],["","80777027315","MODERNA","COVID-19","0","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","30","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","68180035202","SERTRALINE ","TAB 50MG","30","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","",""],["No","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":""}]}]}