{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REILLY   D WALKER","gend":1,"add":"3017 GATEWAY DR APT 302","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1996-02-27","age":"","mstatus":"","insh":"2173059*01","cliId":"","pno":"757\/618-1498","cno":"757\/618-1498","email":"","ename":"","eno":"","pphy":"WADDY, JAMES M MD","ppno":"757\/983-2200","pcpadd":"BLD A SUITE 207 3920 BRIDGE ROAD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":139537,"pcpname":"SMG - Sentara Family Medicine Physicians - BelleHarbour","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/745-7054","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/983-2201","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","N92.6","Z30.09","Z11.3","Z12.4","N94.6","Z30.9","R29.898","M54.31","H10.45","K59.00","R10.84","K29.00","F41.8","R00.2","Z20.828","R05.","R07.9","R07.89"],"date":["2020-03-10","2020-05-29","2020-09-10","2020-09-10","2020-03-10","2020-07-02","2021-01-28","2020-03-27","2020-03-27","2021-06-25","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-10-31","2021-09-10","2021-09-11","2021-10-31","2021-10-31"],"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":[["","00430042014","LO ","1\/10\/10","84","Select","Select",""],["","51862001206","MICROGESTIN ","FE 1\/20","84","Select","Select",""],["","65862094088","AUROVELA ","20-Jan","-84","Select","Select",""],["","00555088602","ESTRADIOL ","1MG","14","Select","Select",""],["","65162006205","SUCRALFATE ","1GM\/10ML","420","Select","Select",""],["","37000045503","PRILOSEC ","20MG","30","Select","Select",""],["","00430042014","LO","10\/1\/10","84","Select","Select",""],["","65862094088","AUROVELA","Jan-20","-84","Select","Select",""],["","00555088602","ESTRADIOL","1MG","14","Select","Select",""],["","51862001206","MICROGESTIN","FE 1\/20","84","Select","Select",""],["","00254101196","SUCRALFATE","1GM\/10ML","-420","Select","Select",""],["","37000045503","PRILOSEC","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":""}]}]}