{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LUANNE MCCARTY","gend":1,"add":"408 YANCEY CT","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1960-08-06","age":"","mstatus":"","insh":"2054128*01","cliId":"","pno":"757\/287-0077","cno":"757\/287-0077, ","email":"","ename":"","eno":"","pphy":"SMITH GRIFFIN, KIMBERLY ANN MD","ppno":"757\/983-5100","pcpadd":"UNIT 100 4214 CHESAPK SQ BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":101283,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Chesapeake Square","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":["L03.012","B07.8","H92.02","R51.","H65.02","Z00.00","Z13.29","Z13.89","Z13.228","Z13.0","Z13.220","Z12.31","I10.","J44.9","C49.6","F17.200","J32.9","J30.1","Z72.0","J32.2","J32.1","M77.11","E03.9","Z85.831","C49.9","K76.0","J34.3","J34.2","Z01.419","Z90.710","Z86.010","K63.5","K57.90","Z83.71","L03.116","D12.8","Z68.27","F17.210"],"date":["2020-03-02","2020-03-02","2020-04-09","2020-04-09","2020-04-09","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2020-11-10","2021-05-18","2021-05-18","2021-01-21","2021-05-18","2020-12-16","2020-12-16","2020-12-16","2020-06-16","2020-06-16","2020-12-10","2021-05-24","2021-01-21","2021-01-21","2021-01-21","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2020-08-10","2021-05-13","2021-05-18","2021-05-18"],"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":[["","00555089902","ESTRADIOL","0.5MG","30","Select","Select",""],["","65862047501","RAMIPRIL","2.5MG","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","32","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","-21","Select","Select",""],["","00597016061","SPIRIVA","1.25MCG","4","Select","Select",""],["","68462029855","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","00591544210","PREDNISONE","10MG","20","Select","Select",""],["","72143021160","DOXYCYCL","50MG","30","Select","Select",""],["","67877021620","CEFUROXIME","500MG","20","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","-30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","2","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":""}]}]}