{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE   W RAMSTAD","gend":1,"add":"1441 FIVEHILL TRL","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1956-10-05","age":"","mstatus":"","insh":"2293063*01","cliId":"","pno":"757\/377-2947","cno":"757\/377-2947","email":"","ename":"","eno":"","pphy":"GALT, MEREDITH C PA","ppno":"757\/318-6911","pcpadd":"2017 PLEASURE HOUSE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","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":["G50.0","G25.0","Z12.31","I42.0","I65.23","I07.1","Z86.73","M48.02","M50.121","M47.22","M54.12","M50.323","M47.812","D48.5","M50.10","Z80.3","I63.033","I63.9","R07.9","G70.00","M54.2","M17.12","R13.10","R63.3","G23.1","R26.9","R47.1","R26.89","R41.841","R26.81","G20.","M25.551","M25.552","R48.8","M25.562"],"date":["2021-04-13","2021-04-13","2021-08-06","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-05-14","2021-05-14","2021-05-14","2021-05-14","2021-06-09","2021-06-09","2020-08-12","2021-05-14","2020-08-03","2021-04-13","2021-04-16","2021-04-16","2021-05-14","2021-06-09","2021-10-01","2021-10-18","2021-08-11","2021-07-30","2021-07-30","2021-10-18","2021-08-06","2021-09-16","2021-08-06","2021-08-06","2021-09-21","2021-09-21","2021-09-16","2021-10-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",null,null,"","","",null,"",null,"","","","",null,null]}},{"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":[["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","90","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","90","Select","Select",""],["","17478007035","ERYTHROMYCIN ","5MG\/GM","-4","Select","Select",""],["","39328010610","PRENATAL ","27-1MG","90","Select","Select",""],["","62175032046","NIACIN ","500MG ER","90","Select","Select",""],["","51991008490","FOLBEE ","","90","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","-90","Select","Select",""],["","43547026810","ROPINIROLE ","0.25MG","180","Select","Select",""],["","68382009801","PAROXETINE ","20MG","30","Select","Select",""],["","00378008501","CARB\/LEVO ","25-100MG","180","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","20","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","90","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","39328010610","PRENATAL","27-1MG","90","Select","Select",""],["","17478007035","ERYTHROMYCIN","5MG\/GM","-4","Select","Select",""],["","65162047810","NITROFURANTN","100MG","20","Select","Select",""],["","62175032046","NIACIN","500MG ER","-90","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","-90","Select","Select",""],["","51991008490","FOLBEE","","30","Select","Select",""],["","43547026810","ROPINIROLE","0.25MG","180","Select","Select",""],["","68382009801","PAROXETINE","20MG","30","Select","Select",""],["","00378008501","CARB\/LEVO","25-100MG","90","Select","Select",""],["","55111015330","ONDANSETRON","4MG","30","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","16729017001","ESCITALOPRAM","20MG","90","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","65862037401","ESCITALOPRAM ","TAB 10MG","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":""}]}]}