{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTINY   T FOLSCHER","gend":1,"add":"2917 E MALDEN AVE","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1994-08-13","age":"","mstatus":"","insh":"2306202*01","cliId":"","pno":"757\/450-5607","cno":"757\/450-5607","email":"","ename":"","eno":"","pphy":"ANDERSON, ROBIN N MD","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9772","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F90.0","M25.532","S62.115A","R52.","H93.8X2","F17.210","Z91.040","Z91.02","Z88.8","Z91.018","N89.8","N73.9","Z72.0","S62.002A","S62.165A","S69.92XA","S62.162D","Z46.89","H43.393","H53.001","N76.0","N92.6","R35.0","B96.89","Z32.02","R10.2","F41.0","F43.12","Z11.3","M79.89","N93.8","R42.","R55.","R53.83","R53.81","F43.10","N93.9"],"date":["2021-08-19","2021-08-19","2021-05-17","2021-03-08","2021-05-17","2021-06-22","2021-06-22","2021-07-30","2021-06-22","2021-07-30","2021-07-30","2020-10-13","2020-10-13","2021-06-22","2021-02-05","2021-02-05","2021-02-05","2021-03-08","2021-03-08","2020-10-13","2020-10-13","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-06-29","2020-06-16","2020-12-24","2021-02-05","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30"],"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":[["","59417010310","VYVANSE ","30MG","30","Select","Select",""],["","29300011416","LAMOTRIGINE ","200MG","-30","Select","Select",""],["","35573042130","ATOMOXETINE ","100MG","30","Select","Select",""],["","69097084905","ESCITALOPRAM ","20MG","30","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","30","Select","Select",""],["","61874011530","VRAYLAR ","1.5MG","30","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","28","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","16","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","4","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","-20","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","51862056406","LOW-OGESTREL ","","84","Select","Select",""],["","00093005805","TRAMADOL ","50MG","8","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00555904958","CRYSELLE-28 ","28 TABS","84","Select","Select",""],["","57896010201","ACETAMINOPHE ","325MG","30","Select","Select",""],["","35573042130","ATOMOXETINE","100MG","30","Select","Select",""],["","59417010310","VYVANSE","30MG","30","Select","Select",""],["","29300011416","LAMOTRIGINE","200MG","-30","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","30","Select","Select",""],["","69097084905","ESCITALOPRAM","20MG","30","Select","Select",""],["","61874011530","VRAYLAR","1.5MG","-30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","24658031205","DOXYCYCL","100MG","28","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","4","Select","Select",""],["","49483060450","IBUPROFEN","800MG","-20","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","15","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","-16","Select","Select",""],["","00555904958","CRYSELLE-28","28 TABS","84","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","57896010201","ACETAMINOPHE","325MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","51862056406","LOW-OGESTREL","","84","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00093005805","TRAMADOL","50MG","8","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":""}]}]}