{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLE   R ALEXANDER","gend":1,"add":"4017 VAUGHAN TOWN CT","city":"VIRGINIA BEACH","state":"VA","zip":"23457-9998","dob":"1984-01-15","age":"","mstatus":"","insh":"1875507*01","cliId":"","pno":"757\/343-1040","cno":"757\/343-1040","email":"","ename":"","eno":"","pphy":"LO, COLETTE W MD","ppno":"757\/252-9800","pcpadd":"1380 TUSCANY DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":117382,"pcpname":"SMG - Sentara Family Medicine Physicians - Nimmo","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"000\/000-0000","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9793","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F43.10","F41.1","M54.16","M51.26","M54.5","R26.2","Z20.828","R06.83","R06.81","R40.0","R53.83","Z72.821","G47.00","G47.8","E66.01","Z82.0","Z68.41","R05.","R53.81","R09.81","R11.0","H93.8X3","E66.9","Z20.822","Z98.890","Z87.442","J39.2","M25.572","M79.672","U07.1","Z09.","J12.89","J31.0","J32.2","R51.9","R06.02","E55.9","D50.9","E88.81","N92.0","Z30.011","M25.372","M76.72","M47.816","Z71.89","Z71.3","E66.09","Z68.38","M51.87","R43.8","Z86.19","Z68.36","R07.9","J98.4","J18.9","M51.36","J06.9","Z30.41","Z79.899","B35.4","D23.9","D22.9","I78.1","L81.4","L82.1","Z12.83","Z71.9","B35.9","D50.0","J02.9","D75.839","R10.30","N93.9","N94.6","N96.","N93.8","N76.0","R10.2","D48.5"],"date":["2021-11-17","2020-09-30","2021-11-17","2020-06-18","2020-06-03","2020-06-03","2020-06-03","2020-11-04","2021-09-22","2021-08-05","2021-09-22","2021-09-22","2021-03-19","2021-08-05","2021-08-05","2021-09-22","2021-09-22","2021-10-03","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-10-03","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2020-07-08","2020-07-08","2020-12-04","2020-11-18","2020-12-04","2020-12-29","2020-12-29","2021-05-10","2021-06-17","2021-04-27","2021-11-22","2021-04-27","2020-05-04","2020-05-04","2020-05-26","2020-05-26","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-05-29","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-05-27","2021-11-02","2021-06-17","2021-08-05","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-08-30","2021-09-22","2021-11-02","2021-10-27","2021-10-04","2021-10-11","2021-10-11","2021-10-11","2021-10-03","2021-10-03","2021-10-03","2021-10-08"],"priorHcc":[null,"",null,"","","","","","","","","","","","","","",null,"","","","","",null,"","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",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":[["","66685100100","AMOX\/K ","875-125","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00093214062","TRI-LO- ","SPRINTEC","-84","Select","Select",""],["","00406037605","HYDROCO\/APAP ","5-300MG","12","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","2","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","-6","Select","Select",""],["","67877057305","BENZONATATE ","100MG","-20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","27808008601","HYD ","10-8\/5ML","100","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","63824000832","MUCINEX ","600MG ER","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","10702002601","PHENTERMINE ","15MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00591544305","PREDNISONE ","20MG","10","Select","Select",""],["","00168009960","KETOCONAZOLE ","2%","-60","Select","Select",""],["","66685100100","AMOX\/K","875-125","14","Select","Select",""],["","00093214062","TRI-LO-","SPRINTEC","-84","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-12","Select","Select",""],["","00406037605","HYDROCO\/APAP","5-300MG","12","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","51862094205","DIAZEPAM","5MG","2","Select","Select",""],["","27808008601","HYD","10-8\/5ML","100","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","-6","Select","Select",""],["","42806071401","BENZONATATE","100MG","20","Select","Select",""],["","63824000832","MUCINEX","600MG ER","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","10702002601","PHENTERMINE","15MG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00591544305","PREDNISONE","20MG","-10","Select","Select",""],["","65862007930","TERBINAFINE","250MG","30","Select","Select",""],["","00168009960","KETOCONAZOLE","2%","-60","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","-12","Select","Select",""],["","62332001771","METRONIDAZOL","500MG","14","Select","Select",""],["","00143980305","DOXYCYCL","100MG","56","Select","Select",""],["","00555902658","JUNEL","Jan-20","84","Select","Select",""],["","51862001206","MICROGESTIN","FE 1\/20","84","Select","Select",""],["","51862001206","MICROGESTIN ","TAB FE 1\/20","84","Select","Select",""],["","65862007930","TERBINAFINE ","TAB 250MG","-30","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","-14","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","84","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","56","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":""}]}]}