{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES   W DORROH","gend":0,"add":"801 BALTIC AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1971-10-29","age":"","mstatus":"","insh":"2160840*01","cliId":"","pno":"757\/560-3029","cno":"757\/560-3029","email":"","ename":"","eno":"","pphy":"ALPER, JASON B DO","ppno":"757\/395-2500","pcpadd":"1024 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117368,"pcpname":"SMG - Sentara Family Medicine Physicians - First Colonial","plan":"OHP","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":["K29.50","K21.9","K52.89","D12.6","R10.9","R19.7","R11.2","R10.13","R10.11","K63.5","K50.90","K31.89","Z83.79","K86.89","K52.9","K63.89","K76.0","K44.9","K42.9","K52.82","K64.0","F17.210","Z79.899","K92.1","K51.40","D12.8","R10.84","K64.9","Z01.818","Z20.828","D12.5","K64.8","K20.80","K63.3","K57.20","K29.80","D12.3","K62.1","K25.9","K51.914"],"date":["2021-04-06","2021-04-06","2021-04-06","2021-04-06","2020-08-13","2021-06-08","2020-08-06","2021-01-28","2021-07-16","2020-08-13","2020-08-13","2021-04-06","2020-07-22","2021-01-28","2021-07-16","2021-04-06","2020-11-13","2020-11-13","2020-11-13","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-08-13","2020-08-13","2020-08-13","2020-12-07","2020-12-07","2021-04-06","2021-04-06","2021-04-06","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13"],"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":[["","68682030930","BUDESONIDE","ER 9MG","30","Select","Select",""],["","59746017306","PREDNISONE","10MG","61","Select","Select",""],["","04142000024","FLORASTOR","250MG","20","Select","Select",""],["","68462043318","COLESEVELAM","625MG","-180","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","-30","Select","Select",""],["","16714083001","MESALAMINE","1.2GM","360","Select","Select",""],["","00832059011","DIPHEN\/ATROP","","360","Select","Select",""],["","00527058601","DICYCLOMINE","10MG","360","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","30","Select","Select",""],["","67877050651","COLESEVELAM ","625MG","60","Select","Select",""],["","68682030930","BUDESONIDE ","ER 9MG","30","Select","Select",""],["","16714083001","MESALAMINE ","1.2GM","360","Select","Select",""],["","59746017310","PREDNISONE ","10MG","90","Select","Select",""],["","00832059011","DIPHEN\/ATROP ","","-360","Select","Select",""],["","04142000024","FLORASTOR ","250MG","20","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","120","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM ","TAB 10MG","-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","",""],["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":""}]}]}