{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY YUNG","gend":1,"add":"3072 PEWTER ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1957-06-18","age":"","mstatus":"","insh":"1881782*01","cliId":"","pno":"757\/463-3841","cno":"757\/463-3841","email":"","ename":"","eno":"","pphy":"ROBLEDO, ELIZABETH MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/532-0192","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":["N64.4","L81.5","Z01.419","E78.5","Z23.","E03.9","Z12.31","J44.9","N95.2","I10.","N89.8","E78.00"],"date":["2020-11-11","2020-12-04","2020-10-27","2021-06-21","2020-10-27","2021-06-21","2020-10-27","2021-06-21","2020-10-27","2021-06-21","2020-12-03","2021-06-21"],"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":[["","00597010061","SPIRIVA","2.5MCG","4","Select","Select",""],["","65862005290","SIMVASTATIN","20MG","30","Select","Select",""],["","31722070190","LOSARTAN","50MG","30","Select","Select",""],["","68180097001","LEVOTHYROXIN","112MCG","90","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","70700010617","CLOBETASOL","0.05%","60","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","-4","Select","Select",""],["","31722070190","LOSARTAN ","50MG","30","Select","Select",""],["","65862005290","SIMVASTATIN ","20MG","30","Select","Select",""],["","68180097001","LEVOTHYROXIN ","112MCG","90","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","70700010617","CLOBETASOL ","0.05%","60","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","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":""}]}]}