{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN   S IRELAND","gend":1,"add":"924 E SPARROW RD","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1957-11-12","age":"","mstatus":"","insh":"2100908*01","cliId":"","pno":"757\/635-1077","cno":"757\/635-1077","email":"","ename":"","eno":"","pphy":"CHOI, HINSING STEVEN MD","ppno":"757\/261-5910","pcpadd":"SUITE 200A 850 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Kempsville","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/523-1053","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9961","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E55.9","E78.2","I10.","K57.90","N30.00","N20.0","N20.1","R31.0","N39.0","N23.","D64.9","N13.2","A41.9","N17.9","R79.89","Z96.0","E27.8","Z01.419","Z12.31","K76.89","R30.0","N30.01","Z87.442","Z79.2","Z79.84","Z79.899","N19.","B96.89","A49.8","Z98.890","Z90.722","Z90.79","N20.2","E79.0","E11.65","R10.13","Z23.","K21.9","N13.30","R78.81","B96.1","R10.32","R11.2","K76.0","R00.0","L60.0","R11.10","A41.59","N13.6","E87.2","I47.1","E83.51","E83.39","E83.42","E87.6","E66.9","Z68.34","Z01.818","I70.0","Z01.812","Z20.822","Z12.12","Z46.6","I51.7"],"date":["2021-05-24","2021-10-22","2021-10-22","2021-10-22","2021-09-10","2020-12-25","2021-09-29","2021-01-25","2021-07-02","2021-10-18","2020-10-26","2021-05-24","2020-12-22","2020-12-25","2020-12-25","2021-06-24","2020-10-26","2021-03-29","2021-04-16","2021-05-13","2020-08-03","2020-08-03","2020-12-19","2021-10-18","2020-10-26","2021-01-18","2021-01-18","2020-12-21","2021-01-25","2021-01-07","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-25","2021-10-22","2021-05-26","2021-10-22","2021-05-24","2020-12-21","2020-12-24","2020-12-24","2020-10-14","2020-10-14","2020-10-14","2021-01-25","2020-01-15","2020-10-12","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2021-01-11","2021-01-11","2021-04-16","2020-10-14","2020-12-24"],"priorHcc":["",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":[["","67877056105","METFORMIN ","500MG","180","Select","Select",""],["","53885099425","ONETOUCH ","ULTRA BL","-75","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","-2","Select","Select",""],["","16729000301","GLIMEPIRIDE ","4MG","180","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","68180021709","LOSARTAN\/HCT ","100-25","90","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","42192080201","PHENAZOPYRID ","200MG","9","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","12","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","-20","Select","Select",""],["","00574014560","TROSPIUM ","20MG","60","Select","Select",""],["","08290236850","LACTINEX ","","50","Select","Select",""],["","68382053701","POT  CITRATE ","1080MG","90","Select","Select",""],["","57237010099","METOPROL ","25MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","60219106901","POT  CHLORIDE","20MEQ ER","30","Select","Select",""],["","00054417925","DEXAMETHASON ","0.5MG","2","Select","Select",""],["","00310620530","FARXIGA ","5MG","90","Select","Select",""],["","67877056105","METFORMIN","500MG","180","Select","Select",""],["","53885024510","ONETOUCH","ULTRA BL","100","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","2","Select","Select",""],["","16729000301","GLIMEPIRIDE","4MG","180","Select","Select",""],["","68180021709","LOSARTAN\/HCT","100-25","90","Select","Select",""],["","42192080201","PHENAZOPYRID","200MG","9","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","12","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","00185012201","NITROFURANTN","100MG","-10","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","57237010099","METOPROL","25MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","7","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","30","Select","Select",""],["","00574014560","TROSPIUM","20MG","60","Select","Select",""],["","08290236850","LACTINEX","","50","Select","Select",""],["","68382053701","POT CITRATE","1080MG","270","Select","Select",""],["","60219106901","POT CHLORIDE","20MEQ ER","30","Select","Select",""],["","00054417925","DEXAMETHASON","0.5MG","2","Select","Select",""],["","00310620530","FARXIGA","5MG","-90","Select","Select",""],["","68382053701","POT CITRA ER","1080MG","-600","Select","Select",""],["","00169413013","OZEMPIC","4MG\/3ML","9","Select","Select",""],["","68382053701","POT  CITRA ER","TAB 1080MG","-600","Select","Select",""],["","00169413013","OZEMPIC ","INJ 4MG\/3ML","9","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}