{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SONJA   F GARRINGER","gend":1,"add":"1900 WESTHAM WOODS PL","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1963-12-05","age":"","mstatus":"","insh":"2058259*01","cliId":"","pno":"757\/721-3178","cno":"757\/721-3178","email":"","ename":"","eno":"","pphy":"MILLER, MITCHELL B MD","ppno":"757\/563-2800","pcpadd":"STE 102 2109 MCCOMAS WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":108567,"pcpname":"Coastal Family Practice PC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/563-2300","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E28.39","Z12.31","Z79.890","R73.01","E78.5","E55.9","J31.0","J00.","R53.83","R05.","J45.30","Z20.828","L72.0","Z12.11","Z01.411","Z13.820","D25.9","Z12.12","N95.1","I48.0","I49.3","I10.","K21.9","Z03.818","Z00.00","F41.1","Z91.010","J30.9","M85.80","D48.5","B35.1","L82.0","Z86.19","Z13.1","Z13.29","F41.9","Z01.419","Z12.39"],"date":["2020-12-04","2020-12-04","2021-11-16","2021-03-09","2021-09-02","2021-09-02","2020-02-03","2020-02-03","2021-09-02","2020-12-04","2021-09-09","2020-11-23","2020-03-03","2021-08-30","2020-09-28","2020-09-28","2021-11-16","2021-11-16","2020-09-28","2020-05-14","2020-05-14","2020-05-14","2021-09-09","2020-06-16","2021-09-09","2021-03-16","2021-03-16","2021-09-09","2021-11-16","2021-02-02","2021-01-27","2021-01-27","2021-01-27","2021-09-02","2021-09-02","2021-09-09","2021-11-16","2021-11-16"],"priorHcc":["","",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":[["","68645052254","SERTRALINE","50MG","135","Select","Select",""],["","65862067705","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","62332000231","FAMOTIDINE","40MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","90","Select","Select",""],["","50742065828","ESTRA\/NORETH","0.5-0.1","-84","Select","Select",""],["","29300022019","MONTELUKAST","10MG","90","Select","Select",""],["","0","","","15","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8","Select","Select",""],["","62332000231","FAMOTIDINE ","40MG","-90","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","50742065828","ESTRA\/NORETH ","0.5-0.1","84","Select","Select",""],["","68645052254","SERTRALINE ","50MG","135","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","65862007930","TERBINAFINE","250MG","90","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","65862007930","TERBINAFINE ","TAB 250MG","90","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":""}]}]}