{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELTON   T RHODES","gend":0,"add":"4500 E HONEYGROVE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1965-07-20","age":"","mstatus":"","insh":"1941438*01","cliId":"","pno":"757\/377-0638","cno":"757\/377-0638","email":"","ename":"","eno":"","pphy":"SOKOL, RICHARD A MD","ppno":"757\/252-9150","pcpadd":"SUITE 810 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":101207,"pcpname":"SMG - Sentara Family Medicine Physicians - Fort Norfolk","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/252-9161","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S23.8XXA","M10.09","E78.00","E78.5","I10.","I25.2","Z91.14","Z79.899","Z95.1","Z95.5","Z87.891","Z88.8","M10.9"],"date":["2020-03-02","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20"],"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":[["","00254200801","COLCHICINE","0.6MG","7","Select","Select",""],["","60505004101","ETODOLAC","400MG","20","Select","Select",""],["","31722053401","METHOCARBAM","750MG","30","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","00527293437","PREDNISONE","20MG","12","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","60505004101","ETODOLAC ","400MG","-20","Select","Select",""],["","31722053401","METHOCARBAM ","750MG","30","Select","Select",""],["","00527293437","PREDNISONE ","20MG","12","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","7","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","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":""}]}]}