{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EUGENE J FARRAR III","gend":0,"add":"513 BIG PINE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1986-04-18","age":"","mstatus":"","insh":"2225454*01","cliId":"","pno":"757\/289-4935","cno":"757\/289-4935, ","email":"","ename":"","eno":"","pphy":"ONAYEMI, OLUSOLA K MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","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":["E10.10","E87.2","N17.9","R11.2","Z86.79","E10.65","D72.829","F17.200","E11.40","L84.","L91.9","M79.609","Z72.0","E78.5","K31.89","R10.84","R07.9","Z20.828","E87.1","Z79.4","E86.0","F17.210","Z91.14","Z83.3","R00.1","D69.6","D64.9"],"date":["2020-04-16","2020-04-15","2020-04-16","2020-04-14","2020-04-14","2020-11-20","2020-04-15","2020-04-15","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-04-16","2020-04-16","2020-04-14","2020-04-14","2020-04-14","2020-10-30","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-14"],"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":[["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","66733082259","INSULIN","100\/ML","15","Select","Select",""],["","00002879959","HUMALOG","100\/ML","-15","Select","Select",""],["","00088221905","LANTUS","100\/ML","-15","Select","Select",""],["","08290320749","BD PEN NEEDL","32GX6MM","-100","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","16477034001","UREA","40%","28","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","",""],["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":""}]}]}