{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAY   E PORTNER","gend":1,"add":"1428 WATER MILL CRK","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1957-08-26","age":"","mstatus":"","insh":"1960330*01","cliId":"","pno":"757\/481-1280","cno":"757\/481-1280","email":"","ename":"","eno":"","pphy":"SULLIVAN, KAREN A MD","ppno":"757\/413-7600","pcpadd":"SUITE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":450016,"pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/481-1280","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9054","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","J30.1","J30.81","J30.89","Z12.11","D12.4","K64.0","Z12.39","J11.1","K63.5","I83.812","J30.0","J45.909","J20.9","I87.2","N39.0","Z13.220","Z13.1","Z13.0","I83.813","Z12.31","Z00.00","R76.8","S69.91XA","J30.9","J01.00"],"date":["2021-09-20","2020-03-20","2020-03-20","2020-03-20","2020-06-11","2020-06-11","2020-06-11","2020-09-04","2020-03-09","2020-06-11","2020-08-19","2020-09-21","2020-01-21","2020-03-09","2020-11-11","2021-04-13","2020-12-01","2020-12-01","2020-12-01","2020-06-25","2021-09-10","2020-12-09","2021-03-03","2021-03-03","2021-09-20","2021-10-01"],"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":[["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","00591024110","LORAZEPAM","1MG","1","Select","Select",""],["","00406048401","APAP\/CODEINE","300-30MG","-20","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","14","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00406048401","APAP\/CODEINE ","300-30MG","-20","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","1","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","14","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","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":""}]}]}