{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW   B CAKE","gend":0,"add":"490 PINE BRANCH CT APT 202","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1964-02-24","age":"","mstatus":"","insh":"1912170*01","cliId":"","pno":"757\/613-8583","cno":"757\/613-8583","email":"","ename":"","eno":"","pphy":"PALTING, JOHN KENNETH MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/288-5633","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9171","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.22","M48.02","L90.5","L57.0","M47.812","M62.81","U07.1","R07.9","M54.12","I10.","D62.","G47.33","D48.5","M25.511","M50.921","M50.922","M50.923","L03.019","L30.9","D04.61","M51.26","Z01.818","Z12.11","M54.2","G89.29","Z01.812","C44.01","I97.42","Z99.89","Z91.19","Z79.899","Z88.8","Z86.718","Z82.3","Z80.0","Z82.49","Z87.891","Z85.828","R58.","G83.9","Z98.1","M50.90","R94.31","Z20.828","G97.31","E78.00","R25.2","H10.13","H61.22","H61.813","L81.4","L82.1","R05.","R50.9","R06.02","Z87.820","Z85.820","L29.9","M25.512","M47.27","N13.2","D72.829","R30.0","N20.1","N20.0","N40.0","N20.2","N13.30","I82.1","G47.30","R03.0"],"date":["2020-01-14","2021-06-29","2021-09-29","2021-09-29","2020-08-24","2020-08-24","2020-12-08","2020-12-08","2020-03-05","2021-09-09","2020-03-05","2020-03-05","2021-09-29","2021-06-29","2020-03-04","2020-03-04","2020-03-04","2020-07-10","2021-04-05","2021-04-05","2021-05-11","2020-02-24","2021-10-18","2020-03-10","2020-03-04","2020-02-13","2020-02-21","2020-03-04","2020-03-04","2020-03-04","2021-09-09","2021-09-09","2020-12-08","2020-03-04","2020-12-08","2020-12-08","2021-09-09","2020-03-04","2020-03-05","2020-03-05","2020-03-05","2020-02-13","2020-02-13","2020-11-20","2020-03-04","2020-12-08","2020-07-22","2021-04-12","2021-05-26","2021-05-26","2020-10-14","2020-10-14","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2021-03-02","2021-06-26","2021-06-29","2021-09-09","2021-09-09","2021-09-09","2021-10-07","2021-10-14","2021-10-14","2021-09-09","2021-09-09","2021-09-29","2021-10-14","2021-10-14"],"priorHcc":["","",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":[["","69097094312","GABAPENTIN","300MG","-90","Select","Select",""],["","13107005501","OXYCODONE","5MG","42","Select","Select",""],["","65862047099","LOSARTAN\/HCT","100-25","-90","Select","Select",""],["","00527293341","PREDNISONE","10MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","63739043210","SENNA\/DSS","8.6-50MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","-50","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","21","Select","Select",""],["","00591352530","LIDOCAINE","5%","-15","Select","Select",""],["","65162019050","NAPROXEN","500MG","10","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","52565005630","TRIAMCINOLON","0.10%","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","65862047099","LOSARTAN\/HCT ","100-25","-90","Select","Select",""],["","13107005501","OXYCODONE ","5MG","42","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","50","Select","Select",""],["","63739043210","SENNA\/DSS ","8.6-50MG","30","Select","Select",""],["","59746017310","PREDNISONE ","10MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","21","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","52565005630","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","00591352530","LIDOCAINE ","5%","-15","Select","Select",""],["","65162019050","NAPROXEN ","500MG","10","Select","Select",""],["","51672138602","FLUOCINONIDE ","0.05%","60","Select","Select",""],["","21922002507","KETOCONAZOLE ","2%","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","15","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","14","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","15","Select","Select",""],["","51672138602","FLUOCINONIDE","0.05%","60","Select","Select",""],["","51672411806","FLUOROURACIL","5%","-40","Select","Select",""],["","21922002507","KETOCONAZOLE","2%","60","Select","Select",""],["","00781202076","AMOXICILLIN","250MG","-30","Select","Select",""],["","11822316500","RA","100MG","10","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","65862059801","TAMSULOSIN ","CAP 0.4MG","14","Select","Select",""],["","51672411806","FLUOROURACIL ","CRE 0.05","-40","Select","Select",""],["","00781202076","AMOXICILLIN ","CAP 250MG","-30","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","15","Select","Select",""],["","42571025101","CLINDAMYCIN ","CAP 150MG","30","Select","Select",""],["","11822316500","RA ","CAP 100MG","10","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":""}]}]}