{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA   LUCIA DUARTE","gend":1,"add":"500 PACIFIC AVE UNIT 307","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1956-04-08","age":"","mstatus":"","insh":"1910193*01","cliId":"","pno":"757\/816-3278","cno":"757\/816-3278","email":"","ename":"","eno":"","pphy":"BAKHSHI, RAJA M MD","ppno":"757\/395-6900","pcpadd":"984B LASKIN ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":117346,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/816-3278","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":["Z11.59","Z03.818","R19.7","R55.","R42.","R07.9","Z87.891","Z79.899","Z91.018","I49.1","Z13.29","Z83.49","J38.5","I50.30","I37.1","R30.0","Z20.828","B34.9","E78.5","E05.90","Z11.1","R07.89","Z53.29","I08.3"],"date":["2020-07-13","2020-07-13","2021-06-18","2020-11-18","2020-10-11","2020-11-18","2020-10-11","2020-11-18","2020-11-18","2020-10-19","2021-03-21","2021-03-21","2021-03-21","2020-11-04","2020-11-04","2020-03-11","2021-01-03","2020-09-10","2020-11-18","2020-11-18","2020-07-20","2020-10-11","2020-10-12","2020-11-04"],"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":[["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","00121085416","SULFATRIM","200-40\/5","-200","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","58602070584","ACID","10MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","65862001205","SERTRALINE ","50MG","30","Select","Select",""],["","00121085416","SULFATRIM ","200-40\/5","-200","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","30","Select","Select",""],["","58602070584","ACID ","10MG","30","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":""}]}]}