{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRADLEY   H DECKER","gend":0,"add":"3538 COLMAR QUARTER","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1975-01-30","pno":"757\/971-9887","cno":"757\/971-9887","email":"","pphy":"SOKOL, RICHARD A MD","ppno":"","pcpadd":"SUITE 810 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":101207,"pcpname":"SMG - Sentara Family Medicine Physicians - Fort Norfolk","insh":"2681498*01","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/672-8452","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/252-9161","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19.072","M21.42","S86.312A","M19.172","R35.0","R07.9","E78.2","R07.89","R79.89","Z82.49","R03.0","M25.572","M25.872","Z20.828","E55.9","H65.91","J30.1","L29.8","H60.8X9","R51.9"],"date":["2021-04-14","2021-04-08","2021-04-14","2021-04-21","2021-09-02","2021-02-16","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-03-18","2021-03-18","2021-01-22","2021-02-10","2021-07-28","2021-10-29","2021-10-29","2021-10-29","2021-10-29"],"priorHcc":["","","","","","","","","","","","","","","","",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":[["","45802000910","FLUOCIN","0.01%","20","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","68180047903","SIMVASTATIN","20MG","30","Select","Select",""],["","80681013100","VITAMIN","5000UNIT","60","Select","Select",""],["","67253090111","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","67253090111","ALPRAZOLAM ","TAB 0.5MG","30","Select","Select",""],["","61314064610","NEO\/POLY\/HC ","SOL 1% OTIC","-10","Select","Select",""],["","80681013100","VITAMIN ","CAP 5000UNIT","30","Select","Select",""],["","45802000910","FLUOCIN ","OIL 0.0001","20","Select","Select",""],["","68180047903","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","17","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00093317431","ALBUTEROL ","AER HFA","17","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":""}]}]}