{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JODI   M NEWLAND","gend":1,"add":"1004 CHALBOURNE DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1973-03-23","age":"","mstatus":"","insh":"2055517*01","cliId":"","pno":"757\/403-2491","cno":"757\/403-2491","email":"","ename":"","eno":"","pphy":"BRITT, CHARLENE MEBANE MD","ppno":"757\/363-6800","pcpadd":"STE 100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":101283,"pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/403-7073","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9023","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K80.20","R94.31","H92.02","R42.","K80.10","R00.1","I10.","F41.9","M32.9","Z68.35","Z79.899","K21.9","R10.13","R19.4","K25.9","K57.90","K64.8","Z12.11","Z20.822","J06.9","Z20.828","R06.83","R53.82","R40.0","F32.9","M79.10","R73.9","R53.83","G47.33"],"date":["2021-03-26","2021-03-23","2021-02-19","2021-02-19","2021-03-24","2021-03-24","2021-08-02","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-08-06","2021-08-06","2021-08-06","2021-04-12","2021-08-06","2021-08-06","2021-08-06","2021-03-22","2021-07-24","2021-07-24","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-10-01","2021-10-01","2021-10-01","2021-11-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","45963070911","METOPROL","25MG ER","90","Select","Select",""],["","00378623301","CITALOPRAM","40MG","90","Select","Select",""],["","51862094205","DIAZEPAM","5MG","12","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","30","Select","Select",""],["","10702001850","OXYCODONE","5MG","10","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","59746012106","MECLIZINE","25MG","30","Select","Select",""],["","65162046650","IBUPROFEN","800MG","60","Select","Select",""],["","45963070911","METOPROL ","25MG ER","90","Select","Select",""],["","00378623301","CITALOPRAM ","40MG","90","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","12","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","30","Select","Select",""],["","10702001850","OXYCODONE ","5MG","10","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","90","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","60","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","90","Select","Select",""],["","61314070101","SULFACET","10% OP","-15","Select","Select",""],["","27241009803","DULOXETINE","30MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","24208067004","SOD","10% OP","-15","Select","Select",""],["","27241009903","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","61314070101","SULFACET ","SOL 10% OP","-15","Select","Select",""],["","24208067004","SOD ","SOL 10% OP","-15","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","",""],["No","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":""}]}]}