{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NINA   A AHERN","gend":1,"add":"1612 FLAMMARION CT","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1973-01-20","age":"","mstatus":"","insh":"2136590*02","cliId":"","pno":"757\/390-9420","cno":"757\/390-9420","email":"","ename":"","eno":"","pphy":"SUN, TOMMY MD","ppno":"757\/507-0305","pcpadd":"STE 300 1950 GLENN MITCHELL","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":140395,"pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/390-1031","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-0306","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.4","R07.9","Z00.00","M25.50","L65.9","J44.9","M54.2","S76.011A","R05.","H11.31","H16.141","N63.15","D64.9","R79.1","R20.9","R35.1","G47.9","F41.0","F41.9","N89.8","Z01.419","N92.1","Z72.0","R61.","Z12.4","Z09.","N63.10","F17.210","Z77.098","M77.8","R52.","R06.00","S76.311A","M76.01","M16.0","M79.18","H16.223","I25.2","E03.9","R68.83","M54.5","Z23.","R94.2","R59.0","M79.622","N91.2","Z20.828","L81.1","L60.8","L81.4","L82.1","Z12.31"],"date":["2021-02-04","2020-04-11","2021-09-27","2020-07-13","2020-09-17","2020-12-28","2021-03-04","2021-05-06","2020-12-28","2020-10-10","2020-10-10","2021-08-12","2021-04-07","2021-03-04","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-01-21","2021-10-07","2020-09-17","2021-02-04","2020-09-17","2020-09-17","2020-12-16","2020-12-16","2020-12-28","2020-12-28","2020-01-06","2020-01-06","2021-01-18","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2020-02-11","2020-04-11","2020-04-11","2020-04-11","2020-04-14","2021-09-27","2021-02-04","2021-08-12","2021-08-12","2021-08-02","2021-07-22","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-10-07"],"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":[["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","-14","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","10","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","12","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-12","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","-14","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","10","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","12","Select","Select",""],["","00069046903","CHANTIX","1MG","168","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","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":""}]}]}