{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA PAYNE","gend":1,"add":"411 CHATTERTON DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1958-05-02","age":"","mstatus":"","insh":"2279510*01","cliId":"","pno":"540\/630-1110","cno":"540\/630-1110","email":"","ename":"","eno":"","pphy":"ONAYEMI, OLUSOLA K MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/431-2805","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":["Z12.31","N81.10","R31.9","R59.0","J18.9","R91.8","K76.89","N17.9","E87.5","N17.0","J90.","R06.02","J96.01","J96.02","C91.50","C85.93","C85.20","Z49.02","R10.9","R19.4","Z03.89","R18.8","C85.90","R11.2","F43.22","F41.9","R53.0","Z51.5","R07.9","R79.1","J18.1","R59.1","R60.0","G93.40","E87.2","R91.1","F41.8","T82.528A","T82.598A","R40.4","R41.0","Z46.82","R16.0","K83.8","R79.89","A41.9","J98.11","R19.7","E03.9","Z99.2","E88.3","H57.89","Z00.00","R05.","C85.28","R59.9","K57.30","Z98.890","A49.8","C84.40","Z45.2","N19.","R22.2","K82.9","R94.5","I82.409","C34.91","C78.7","J96.00","K76.9","Z85.72","I95.9","J30.89","H10.13","C34.90","C76.2","E83.39","I83.893","Z87.820","Z91.09","R07.89","E87.70","R53.1","E87.6","D49.0","R06.89","T59.7X4A","R60.9","R13.10","R63.3"],"date":["2021-01-14","2021-02-17","2021-02-17","2021-07-08","2021-07-20","2021-07-28","2021-06-06","2021-07-26","2021-06-14","2021-07-23","2021-07-25","2021-07-10","2021-06-15","2021-06-15","2021-06-11","2021-06-19","2021-06-19","2021-06-23","2021-07-27","2021-06-24","2021-06-27","2021-07-20","2021-07-28","2021-07-19","2021-07-22","2021-07-27","2021-07-27","2021-07-27","2021-07-10","2021-05-31","2021-06-29","2021-06-07","2021-06-05","2021-06-08","2021-06-09","2021-06-13","2021-07-11","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-07-08","2021-06-16","2021-06-16","2021-06-18","2021-06-17","2021-07-13","2021-06-22","2021-06-23","2021-06-23","2021-07-21","2020-11-21","2021-01-08","2021-06-11","2021-06-03","2021-06-07","2021-06-07","2021-07-10","2021-07-08","2021-06-07","2021-06-09","2021-06-09","2021-06-09","2021-06-11","2021-06-17","2021-06-22","2021-07-10","2021-07-04","2021-07-04","2021-06-29","2021-07-20","2021-06-21","2021-01-08","2021-01-08","2021-06-29","2021-06-29","2021-07-26","2020-11-25","2020-11-25","2020-11-25","2021-05-18","2021-06-28","2021-07-18","2021-07-22","2021-05-31","2021-06-09","2021-06-09","2021-06-15","2021-07-07","2021-07-07"],"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":[["","00378064205","PREDNISONE ","20MG","6","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","50111056001","TRAZODONE ","50MG","90","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","27808008602","HYD ","10-8\/5ML","35","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","4","Select","Select",""],["","69842080601","CVS ","600MG","20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","17478076206","DRONABINOL ","5MG","60","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":""}]}]}