{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXIS   N PISHVAZADEH","gend":1,"add":"121 E BAYVIEW BLVD","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1989-02-13","age":"","mstatus":"","insh":"2240844*01","cliId":"","pno":"757\/774-2234","cno":"757\/774-2234","email":"","ename":"","eno":"","pphy":"MPOY KANYINDA, JEAN MARIE K MD","ppno":"757\/388-9925","pcpadd":"7401 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Wards Corner","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":["M47.812","G93.5","Z20.828","F17.210","R06.02","Q07.00","R26.0","H55.00","Q04.8","Q76.49","Z87.820","S06.9X0A","Z00.00","R79.89","Z03.818","Z11.59","Q75.8","M43.12","M40.13","M48.02","M48.03","R51.","R39.11","S09.90XA","S06.9X9A","H91.90","Z98.1","Z01.419","N76.0","R39.9"],"date":["2020-07-14","2020-07-14","2020-12-29","2020-12-27","2020-12-27","2021-02-23","2021-01-18","2020-02-20","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2021-03-03","2020-01-28","2020-07-13","2020-07-13","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-08-31","2021-03-03","2020-02-18","2020-02-20","2020-02-20","2020-07-14","2021-07-08","2021-07-08","2021-07-08"],"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":[["","11534018701","BUT\/APAP\/CAF","","-60","Select","Select",""],["","00143147701","PREDNISONE","20MG","20","Select","Select",""],["","51672402301","ACETAZOLAMID","250MG","60","Select","Select",""],["","59676058005","JANSSEN","COVID-19","0","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","60","Select","Select",""],["","00054001825","PREDNISONE ","20MG","20","Select","Select",""],["","51672402301","ACETAZOLAMID ","250MG","60","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","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":""}]}]}