{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AVELINO   T MAGGAY","gend":0,"add":"210 GRANT ST","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1954-11-29","pno":"757\/842-1682","cno":"757\/842-1682","email":"","pphy":"ESPIRITU, KEITH MD","ppno":"","pcpadd":"213 RIVER WALK PKWY STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":700507,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Riverwalk","insh":"2001207*01","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9043","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R97.20","K40.90","R39.9","J96.01","J18.9","U07.1","E87.6","I48.91","Z12.5","Z00.00","Z13.220","Z12.11","N40.0","J12.82","R74.01","R00.0","R06.02","R07.9","R79.1","M25.562","Z23.","H91.90","K40.91","Z79.899","Z87.891","Z98.890","R06.00","J80.","E87.1","Z20.822","I48.0","R79.89","R07.2","I21.A1","Z79.01","K59.00","Z82.49","I25.10","I21.4","J96.00"],"date":["2021-11-19","2021-05-19","2021-11-19","2021-09-27","2021-09-18","2021-09-28","2021-09-27","2021-10-15","2020-03-17","2020-03-17","2020-03-17","2021-08-27","2021-09-27","2021-09-28","2021-09-19","2021-09-15","2021-09-15","2021-09-23","2021-09-23","2020-09-03","2020-03-17","2021-09-15","2021-06-25","2021-09-15","2021-09-15","2021-06-25","2021-09-15","2021-09-15","2021-09-18","2021-09-15","2021-09-27","2021-09-23","2021-09-28","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-24","2021-09-25"],"priorHcc":[null,"",null,null,"",null,null,null,"","","","",null,null,null,"","","","","","",null,"",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":[["","68382013201","TAMSULOSIN","0.4MG","90","Select","Select",""],["","68462019005","NAPROXEN","500MG","30","Select","Select",""],["","00406055201","OXYCODONE","5MG","28","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","59088010959","MULTIVIT\/FL","1MG","30","Select","Select",""],["","68382073901","MIDODRINE","10MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","-90","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","-60","Select","Select",""],["","59088010959","MULTIVIT\/FL ","CHW 1MG","30","Select","Select",""],["","68382073901","MIDODRINE ","TAB 10MG","-90","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","28","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":""}]}]}