{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DAVID A LEON","gend":0,"add":"6006 OCEAN FRONT AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1964-07-21","age":"","mstatus":"","insh":"1960743*01","cliId":"","pno":"757\/354-3636","cno":"757\/354-3636, 757\/354-3636, ","email":"","ename":"","eno":"","pphy":"BAKHSHI, RAJA M MD","ppno":"757\/395-6900","pcpadd":"984B LASKIN ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23451-9998","pcpcounty":"","pcpid":117346,"pcpname":"SMG - Sentara Primary Care & Therapy Center - Oceanfront","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","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":["N52.9","R82.81","F43.22","D22.62","D22.5","L57.0","L82.0","L81.8","N35.812","G47.33","F32.9","F41.9","Z79.899","N35.919","N35.912","Z20.828","Z99.89","R39.15","E78.5","E66.3","E88.81","Z87.448","R82.998","D48.5","D18.01","L81.4","D22.61","N53.19","F52.32","R35.1","I48.0","N41.1","F43.21","J30.9","G43.109","M47.22","M77.12","R33.9","Z01.812","Z23.","M25.522","Z71.3","Z71.89","R79.89","Z01.810"],"date":["2020-12-16","2020-08-21","2021-06-07","2021-02-22","2021-02-22","2020-08-21","2021-02-22","2021-02-22","2020-12-16","2021-05-13","2020-12-16","2020-12-16","2020-12-16","2021-01-13","2021-04-14","2021-01-11","2021-05-03","2020-03-10","2021-05-03","2020-09-30","2020-12-15","2021-01-28","2021-01-28","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-04-14","2021-04-14","2021-04-14","2021-05-03","2020-04-13","2020-04-13","2020-01-06","2020-01-06","2020-04-13","2020-05-28","2020-12-07","2020-12-14","2021-03-13","2020-06-11","2020-08-05","2020-11-18","2020-02-27","2020-12-07"],"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":[["","13668013610","ESCITALOPRAM","10MG","30","Select","Select",""],["","51672136307","DICLOFENAC","3%","100","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","56","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","31722072610","MONTELUKAST","10MG","30","Select","Select",""],["","66993096159","METRONIDAZOL","0.75%","-59","Select","Select",""],["","50383066730","LIDO\/PRILOCN","2.5-2.5%","-30","Select","Select",""],["","70710140103","CLOBETASOL","0.05%","-120","Select","Select",""],["","61748047060","DESONIDE","0.05%","-60","Select","Select",""],["","00713065540","TRIAMCINOLON","DEN 0.1%","-5","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","27241011403","TADALAFIL","20MG","10","Select","Select",""],["","27241006903","SILDENAFIL","100MG","10","Select","Select",""],["","68462019705","PRAVASTATIN","40MG","90","Select","Select",""],["","00904705952","TROSPIUM","20MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","-60","Select","Select",""],["","50742011808","CABERGOLINE","0.5MG","8","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00904645780","DOK","100MG","30","Select","Select",""],["","31722070590","VALACYCLOVIR","1GM","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":""}]}]}