{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUAN   A ARAIZA","gend":0,"add":"1636 JANKE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1957-02-05","age":"","mstatus":"","insh":"1849217*02","cliId":"","pno":"757\/460-9491","cno":"757\/460-9491","email":"","ename":"","eno":"","pphy":"ANDERSON, ROBIN N MD","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/460-9491","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9772","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C20.","M48.061","M47.816","Z51.0","Z51.11","Z93.3","C7A.026","Z79.899","R91.8","R59.0","D50.9","M25.559","R03.0","M25.569","N40.0","R10.9","Z12.11","K63.5","D3A.026","R91.1","E04.1","N28.1","C7B.09","Z87.891","Z80.0","Z43.3","D50.0","D50.8","D63.0","Z23.","Z00.00","C77.2","G89.18","Z71.89","R19.7","N39.0","D64.9","B96.81","Z40.9","E27.9","Z85.048","Z98.0","R19.4","R63.4","K21.9","K29.30","D37.8","Z93.2","Z45.2","Z85.040","E27.8","Z92.21","Z92.3","R19.8","K29.90","C77.5","K11.8","M16.12","Z98.890","C18.9","K46.9","C78.00"],"date":["2021-09-29","2020-08-26","2020-08-26","2020-12-01","2020-12-01","2021-09-29","2021-09-29","2021-07-19","2021-09-29","2021-09-29","2021-09-08","2020-01-14","2020-01-14","2020-01-14","2020-08-05","2020-08-05","2020-08-31","2020-08-17","2020-09-03","2021-01-04","2020-08-28","2021-08-30","2020-09-14","2020-10-02","2020-09-14","2021-11-01","2021-04-19","2021-06-02","2021-09-29","2021-04-10","2021-05-03","2020-09-14","2020-09-14","2021-01-15","2020-08-25","2020-08-05","2020-08-24","2020-08-24","2020-09-14","2021-01-04","2021-07-20","2021-02-08","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-09-22","2020-09-22","2021-01-18","2021-05-24","2021-05-24","2021-09-24","2021-09-24","2021-03-22","2020-08-18","2020-10-14","2020-10-14","2020-10-14","2021-08-30","2021-08-30","2021-08-30","2021-09-24"],"priorHcc":[null,"","","","",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":[["","00406048410","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","20","Select","Select",""],["","72485020512","CAPECITABINE","500MG","-150","Select","Select",""],["","57237007630","ONDANSETRON","8MG","60","Select","Select",""],["","43199001101","HYOSCYAMINE","0.125MG","-60","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","69238148501","ERYTHROMYCIN","500MG BS","-6","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","00093117701","NEOMYCIN","500MG","6","Select","Select",""],["","52565000730","LIDO\/PRILOCN","2.5-2.5%","30","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","-20","Select","Select",""],["","49884068905","METOCLOPRAM","10MG","3","Select","Select",""],["","65162062711","TRAMADOL","50MG","-40","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","11523723403","MIRALAX","3350 NF","-238","Select","Select",""],["","43386031208","GAVILAX","","238","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","12","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","43199001101","HYOSCYAMINE ","0.125MG","60","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","69238148501","ERYTHROMYCIN ","500MG BS","6","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","20","Select","Select",""],["","65162062711","TRAMADOL ","50MG","40","Select","Select",""],["","00093117701","NEOMYCIN ","500MG","6","Select","Select",""],["","45802086802","POLYETH ","3350 NF","-238","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","49884068905","METOCLOPRAM ","10MG","3","Select","Select",""],["","43386031208","GAVILAX ","","238","Select","Select",""],["","11523723403","MIRALAX ","3350 NF","-238","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","20","Select","Select",""],["","72485020512","CAPECITABINE ","500MG","150","Select","Select",""],["","52565000730","LIDO\/PRILOCN ","2.5-2.5%","30","Select","Select",""],["","68382004001","PROMETHAZINE ","12.5MG","10","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":""}]}]}