{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAILEY   R WICKER","gend":1,"add":"3537 BYRNBRAE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1994-07-09","age":"","mstatus":"","insh":"2269639*01","cliId":"","pno":"757\/439-3767","cno":"757\/439-3767","email":"","ename":"","eno":"","pphy":"SULLIVAN, KAREN A MD","ppno":"757\/413-7600","pcpadd":"SUITE 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\/507-9054","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.90","M25.531","F33.1","S93.602A","Z01.419","Z12.4","Z11.3","Z30.9","J01.41","R05.","B37.9","T36.95XA","Z00.00","J30.1","Z13.220","Z13.0","Z13.1","F32.1","E66.3","Z11.4","Z23.","S93.402A","M24.272","M25.572","S93.492A","B34.9","F41.9","Z20.828","R41.840","Z11.59"],"date":["2021-09-30","2021-03-29","2021-11-17","2021-08-20","2021-11-11","2021-11-11","2020-02-12","2021-11-11","2021-07-17","2021-07-17","2021-07-17","2021-07-17","2021-11-04","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-02-12","2021-11-03","2021-09-16","2021-09-16","2021-09-16","2021-09-02","2021-09-28","2021-11-11","2021-09-28","2021-11-03","2021-11-04"],"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":[["","16714036004","MONO-LINYAH ","0.25-35","84","Select","Select",""],["","00555901658","SPRINTEC ","28 DAY","84","Select","Select",""],["","13107006101","PHENTERMINE ","37.5MG","30","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","68180031906","BUPROPN ","150MG XL","90","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","31722095801","BENZONATATE ","200MG","21","Select","Select",""],["","11822331550","RA ","24 HOUR","30","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","76385012350","METHOCARBAM ","500MG","40","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","60","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","16714036004","MONO-LINYAH","0.25-35","84","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","84","Select","Select",""],["","13107006101","PHENTERMINE","37.5MG","30","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","68180031906","BUPROPN","150MG XL","90","Select","Select",""],["","11822331550","RA","24 HOUR","30","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","60","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","31722095801","BENZONATATE","200MG","21","Select","Select",""],["","76385012350","METHOCARBAM","500MG","40","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","20","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP ","TAB 5-325MG","18","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","20","Select","Select",""],["","68180084073","NORGEST\/ETHI ","TAB 0.25\/35","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":[[["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":""}]}]}