{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMBER   L PATTERSON","gend":1,"add":"824 MOFFAT LN","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1988-06-27","age":"","mstatus":"","insh":"2259820*01","cliId":"","pno":"757\/228-0003","cno":"757\/228-0003","email":"","ename":"","eno":"","pphy":"JAVIER, FRANCIS V MD","ppno":"757\/413-7600","pcpadd":"STE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":450016,"pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-7938","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","N92.6","Z23.","R05.","Z20.828","F90.9","F42.9","F39.","S46.819A","J06.9","R30.0","J20.9","F31.0","F90.1","F42.2","G43.911"],"date":["2020-02-13","2020-02-13","2020-02-13","2020-07-24","2020-07-24","2021-08-17","2021-08-17","2021-08-17","2021-02-23","2020-07-24","2020-01-02","2020-12-18","2020-04-03","2020-04-03","2020-04-03","2021-07-06"],"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":[["","69543025216","VIRTUSSIN","100-10\/5","100","Select","Select",""],["","00143980305","DOXYCYCL","100MG","7","Select","Select",""],["","13811071910","NITROFURANTN","100MG","6","Select","Select",""],["","13811071030","METHYLPHENID","72MG ER","30","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","Select","Select",""],["","50458058601","CONCERTA","36MG","60","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","00378727253","NORETHINDRON","0.35MG","28","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00527217037","DICLOFENAC","100MG ER","14","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","90","Select","Select",""],["","00781107710","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","33342006807","OLANZAPINE","5MG","30","Select","Select",""],["","67877043203","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","7","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","6","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","6","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","100","Select","Select",""],["","13811071030","METHYLPHENID ","72MG ER","30","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30","Select","Select",""],["","61874013030","VRAYLAR ","3MG","30","Select","Select",""],["","50458058601","CONCERTA ","36MG","60","Select","Select",""],["","00378727253","NORETHINDRON ","0.35MG","-28","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","33342006807","OLANZAPINE ","5MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE ","25MG","42","Select","Select",""],["","00527217037","DICLOFENAC ","100MG ER","14","Select","Select",""],["","65862014736","SUMATRIPTAN ","50MG","-9","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","-30","Select","Select",""],["","67877043203","ARIPIPRAZOLE ","10MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00228277811","PROPRANOLOL ","60MG ER","30","Select","Select",""],["","00781107710","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","20","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":""}]}]}