{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD   P GEERS","gend":0,"add":"3440 NEW CASTLE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1961-01-31","age":"","mstatus":"","insh":"1868543*01","cliId":"","pno":"757\/286-3474","cno":"757\/286-3474","email":"","ename":"","eno":"","pphy":"CURULLA, RICHARD MD","ppno":"757\/507-0900","pcpadd":"STE 202 1925 GLENN MITCHELL D","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Princess Anne","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/340-2870","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/301-6462","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","M25.551","M87.051","Z12.11","Z86.010","D12.2","D12.3","D12.4","K64.0","E11.9","E66.01","I10.","E78.5","M19.90","G47.33","Z68.42","Z86.718","Z79.84","Z79.82","Z79.899","Z88.1","L90.5","L82.1","Z71.9","Z01.812","R10.84","Z20.822","D48.5","C44.1122","C44.612","E11.65","K63.5","K64.8","Z96.649","S72.009A","L53.9","L57.0","L91.8","I87.2","L81.4","D18.00","L57.8","D22.9","Z85.828","Z12.83","E66.9"],"date":["2020-09-14","2021-05-03","2021-05-03","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-09-23","2021-02-16","2021-06-08","2021-06-08","2021-06-08","2021-09-08","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-06-29","2021-06-29","2021-06-29","2021-02-13","2021-02-13","2021-02-13","2020-10-27","2020-10-07","2020-10-07","2021-04-27","2021-02-16","2021-02-16","2021-05-22","2021-05-22","2020-10-27","2020-10-27","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-09-08"],"priorHcc":["","","","","","","","","",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":[["","53489012002","DOXYCYCL","100MG","20","Select","Select",""],["","00093321992","KETOCONAZOLE","2%","60","Select","Select",""],["","00378718705","METFORMIN","1000MG","60","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","16","Select","Select",""],["","64980028105","GLIPIZIDE","10MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","-60","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","68180072103","AMLODIPINE","10MG","-90","Select","Select",""],["","65862020399","LOSARTAN","100MG","90","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","90","Select","Select",""],["","51862036240","FLUOROURACIL","5%","-40","Select","Select",""],["","00168009960","KETOCONAZOLE ","2%","60","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","16","Select","Select",""],["","51862036240","FLUOROURACIL ","5%","-40","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","20","Select","Select",""],["","65862020399","LOSARTAN ","100MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","-60","Select","Select",""],["","64980028105","GLIPIZIDE ","10MG","-30","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","-90","Select","Select",""],["","00378718705","METFORMIN ","1000MG","60","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","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":""}]}]}