{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANETTE KNIGHT","gend":1,"add":"7800 ODGEN AVE C","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1963-12-20","age":"","mstatus":"","insh":"1854579*01","cliId":"","pno":"757\/537-0494","cno":"757\/537-0494","email":"","ename":"","eno":"","pphy":"FORMATO, ERICA L MD","ppno":"757\/983-8650","pcpadd":"STE 100 2760 GODWIN BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":177933,"pcpname":"SMG - Sentara Family Medicine & Walk-In - Suffolk","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/983-8673","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.818","M17.11","E11.69","I10.","E78.2","G47.30","M25.761","E11.9","D62.","J02.9","E78.5","E78.00","E66.9","Z68.33","Z79.899","Z79.1","Z79.84","Z88.2","Z96.651","Z47.1","Z79.82","Z91.81","Z20.822","R50.9","B34.9","Z20.828","Z01.812","M17.0","G89.18","M79.604","R10.9","H10.30","Z03.818","Z11.59","H25.13","I87.2","M25.651","R43.8","M67.442","M79.671","M71.21","Q65.89"],"date":["2020-12-14","2020-12-23","2021-04-07","2021-04-07","2021-04-07","2021-01-06","2020-12-22","2021-01-06","2020-12-22","2020-12-22","2020-12-23","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2021-01-06","2020-12-22","2021-02-03","2021-02-03","2021-01-06","2021-01-06","2021-03-21","2020-02-11","2020-02-11","2020-12-18","2020-12-18","2020-12-22","2020-12-22","2021-01-12","2020-03-17","2020-10-31","2020-08-28","2020-08-28","2020-11-25","2021-01-12","2021-01-21","2020-06-16","2020-08-07","2020-08-07","2020-10-19","2020-10-19"],"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":[["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","49884017311","AMLOD\/VALSAR","\/HCTZ","30","Select","Select",""],["","68382005005","MELOXICAM","7.5MG","-60","Select","Select",""],["","57237004001","PENICILLN","250MG","-30","Select","Select",""],["","50742061501","METOPROL","25MG ER","30","Select","Select",""],["","68645051654","AMLODIPINE","10MG","90","Select","Select",""],["","65862084003","MOXIFLOXACIN","HCL 0.5%","-3","Select","Select",""],["","67877015905","METFORMIN","500MG ER","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","68645048154","ATORVASTATIN","20MG","90","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","68645056354","IBUPROFEN","800MG","15","Select","Select",""],["","00904678480","ASPIRIN","325MG EC","30","Select","Select",""],["","62332008390","VALSART\/HCTZ","320-25MG","90","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00078056330","EXFORGEH\/10-","320-25","30","Select","Select",""],["","49884017311","AMLOD\/VALSAR ","\/HCTZ","-30","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","10","Select","Select",""],["","45963070996","METOPROL ","25MG ER","30","Select","Select",""],["","65162017810","METFORMIN ","500MG ER","90","Select","Select",""],["","57237004001","PENICILLN ","250MG","30","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","15","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","68645048154","ATORVASTATIN ","20MG","90","Select","Select",""],["","68382005005","MELOXICAM ","7.5MG","60","Select","Select",""],["","65862084003","MOXIFLOXACIN ","HCL 0.5%","3","Select","Select",""],["","00904678480","ASPIRIN ","325MG EC","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","40","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","90","Select","Select",""],["","00078056330","EXFORGEH\/10- ","320-25","30","Select","Select",""],["","62332008390","VALSART\/HCTZ ","320-25MG","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":""}]}]}