{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NICOLE M WEBER","gend":1,"add":"587 GRANT AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1983-09-13","age":"","mstatus":"","insh":"2086833*01","cliId":"","pno":"757\/969-7325","cno":"757\/969-7325, ","email":"","ename":"","eno":"","pphy":"ROBLEDO, ELIZABETH MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","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":["F33.1","F41.9","R45.851","F39.","F41.0","F51.02","Z86.59","F51.04","F41.8","Z65.8","Z72.0","R06.02","R07.9","J40.","F33.2","Z20.828","J45.20","Z87.891","Z71.9"],"date":["2021-04-23","2021-04-23","2021-06-07","2021-06-07","2021-06-07","2021-06-04","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2021-02-16","2021-02-16","2021-02-16","2020-06-17","2021-01-12","2021-04-13","2021-04-13","2021-04-13"],"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":[["","00093083205","CLONAZEPAM","0.5MG","60","Select","Select",""],["","43386035101","HYDROCO\/APAP","5-300MG","12","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","68382003416","VENLAFAXINE","37.5 ER","-30","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","65862019405","FLUOXETINE","40MG","60","Select","Select",""],["","43547030203","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","1","Select","Select",""],["","00173071820","FLOVENT","44MCG","11","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","30698042312","EQUETRO","300MG","180","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","6","Select","Select",""],["","00054002125","LITHIUM","300MG ER","60","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","16571068101","CARBAMAZEPIN","200MG ER","60","Select","Select",""],["","00406895401","AMPHET\/DEXTR","20MG ER","30","Select","Select",""],["","54092038701","ADDERALL","20MG","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","",""],["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":""}]}]}