{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA BRANDT","gend":1,"add":"5343 CLAY BANK RD","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1956-09-21","age":"","mstatus":"","insh":"2260028*02","cliId":"","pno":"757\/876-4397","cno":"757\/876-4397","email":"","ename":"","eno":"","pphy":"LANGER, JANICE M MD","ppno":"757\/984-6110","pcpadd":"STE 200 4374 NEW TOWN AVE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":130405,"pcpname":"SMG - Sentara Family Medicine Physicians - New Town","plan":"OHP","program":"ACA","lob":"Individual","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":["M48.02","M50.322","M50.323","M50.321","E78.00","E78.5","E55.9","R73.9","J01.90","M43.02","M47.22","Z12.31","Z13.820","Z78.0","M85.89","R63.4","M54.5","M54.41","M81.6","F33.41","F41.9","G89.29","M85.80","M47.812","M43.16","Z00.00","M50.30","M51.36","Z28.21","M54.12","M43.17","M54.2","M51.37"],"date":["2020-10-06","2020-07-15","2020-10-06","2021-02-25","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2020-01-17","2020-10-06","2020-10-06","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-05-12","2020-11-09","2021-05-12","2021-05-12","2021-05-12","2020-05-06","2021-05-12","2021-06-25","2021-02-25","2021-02-25","2020-11-09","2020-12-16","2020-11-09","2020-11-09","2020-12-16","2021-02-25","2021-02-24","2021-02-25"],"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":[["","67877022210","GABAPENTIN ","100MG","90","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","5","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69452014320","BENZONATATE ","100MG","40","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","00093005805","TRAMADOL ","50MG","28","Select","Select",""],["","59762121003","DESVENLAFAX ","25MG ER","30","Select","Select",""],["","00093005405","BUSPIRONE ","10MG","90","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","90","Select","Select",""],["","68382005105","MELOXICAM ","15MG","90","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":""}]}]}