{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDSEY   KAY COOK","gend":1,"add":"3713 SUMMER PL","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1997-01-19","age":"","mstatus":"","insh":"2309397*02","cliId":"","pno":"757\/348-0293","cno":"757\/348-0293","email":"","ename":"","eno":"","pphy":"CALLAHAN, ROBERT D MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/348-0293","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9004","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.9","M54.5","G11.4","R73.01","G89.11","M79.18","F17.210","E66.9","Z68.33","Z87.81","Z91.040","Z88.8","Z88.0","Z91.048","Z90.89","M79.642","M25.531","R29.898","G89.29","K08.89","K02.9","R22.0","A69.1","G25.82","Z99.3","R50.9","S69.92XA","R53.1"],"date":["2021-05-18","2021-01-05","2021-08-10","2021-05-18","2021-05-18","2021-07-04","2021-07-04","2021-08-02","2021-07-04","2021-07-04","2021-07-04","2021-08-02","2021-08-02","2021-08-02","2021-07-28","2021-07-04","2021-07-04","2021-07-04","2021-08-03","2021-08-03","2021-07-28","2021-08-02","2021-07-28","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-07-04","2021-08-10"],"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":[["","69097083412","SERTRALINE","50MG","90","Select","Select",""],["","00832105515","BACLOFEN","20MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","-30","Select","Select",""],["","69097083412","SERTRALINE ","50MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","00832105515","BACLOFEN ","20MG","90","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","90","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","0","","","105","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","59779043262","NASAL","30MG","24","Select","Select",""],["","65862050220","AMOX\/K","500-125","20","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","90","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","59779043262","NASAL ","TAB 30MG","24","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","20","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":""}]}]}