{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY SOLIS","gend":1,"add":"4773 POST OAK DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1997-06-22","age":"","mstatus":"","insh":"3622614*04","cliId":"","pno":"757\/406-4340","cno":"757\/406-4340","email":"","ename":"","eno":"","pphy":"NELSON, MERRILYN E DO","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\/615-9717","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/226-0247","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","F34.1","R19.7","K30.","K29.70","J45.50","S61.432A","Z79.52","M30.1","R82.71","J32.4","D72.18","J33.9","Z01.419","J82.","Z11.3","Z12.4","R87.612","Z30.017","Z23.","Z02.83","A08.4","Z98.890","Z00.00","R41.840","Z11.1","K50.90","J45.909","K52.9","R45.1","R60.9","Z88.0","Z88.8","Z79.3","Z79.899","Z79.51","Z87.891","Z86.19","J45.51","N94.6","N92.6","D72.1","R76.0","R00.0","F41.9","J31.0","J32.8","J34.3","J34.9","J32.1","J32.2","F90.2","J32.0","N89.8","J32.3","J32.9","J34.89","E66.9","F32.A","Z30.46","Z12.39"],"date":["2021-08-23","2021-08-23","2020-03-06","2020-03-06","2020-03-06","2021-11-18","2020-06-11","2021-07-01","2021-11-18","2020-12-18","2021-08-02","2021-10-08","2021-10-12","2021-11-08","2020-09-23","2021-08-10","2021-11-08","2021-10-26","2021-05-19","2021-10-22","2021-05-25","2021-04-13","2021-04-30","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-07-01","2020-03-06","2020-03-06","2020-03-06","2021-07-01","2021-07-01","2020-03-06","2021-07-01","2020-03-06","2021-07-01","2020-03-06","2021-10-08","2021-05-04","2021-05-04","2020-01-15","2020-01-15","2020-06-26","2021-07-01","2021-07-08","2021-07-01","2021-07-01","2021-07-01","2021-07-08","2021-10-12","2021-10-22","2021-10-12","2021-08-10","2021-07-01","2021-11-18","2021-07-01","2021-10-08","2021-10-26","2021-10-26","2021-11-08"],"priorHcc":["","","","","",null,"","",null,"","",null,null,null,"","",null,null,"",null,"","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","",null,null,null,"","",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":[["","00591292754","LEVALBUTEROL","45\/ACT","15","Select","Select",""],["","50580066910","SUDAFED","240MG","30","Select","Select",""],["","00591544301","PREDNISONE","20MG","90","Select","Select",""],["","00555904958","CRYSELLE-28","28 TABS","84","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","31722070430","VALACYCLOVIR","500MG","-90","Select","Select",""],["","00310183030","FASENRA","30MG\/ML","-1","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","20","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","90","Select","Select",""],["","51862056406","LOW-OGESTREL","","84","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","53489011905","DOXYCYCL","100MG","28","Select","Select",""],["","0","","","600","Select","Select",""],["","00591544301","PREDNISONE ","20MG","90","Select","Select",""],["","50580066910","SUDAFED ","240MG","30","Select","Select",""],["","00591292754","LEVALBUTEROL ","45\/ACT","15","Select","Select",""],["","31722070430","VALACYCLOVIR ","500MG","90","Select","Select",""],["","00555904958","CRYSELLE-28 ","28 TABS","84","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","20","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","90","Select","Select",""],["","00310183030","FASENRA ","30MG\/ML","1","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","51862056406","LOW-OGESTREL ","","-84","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","00527150237","AMPHET\/DEXTR ","10MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","2%","-22","Select","Select",""],["","00527150237","AMPHET\/DEXTR","10MG","30","Select","Select",""],["","00093101042","MUPIROCIN","2%","-22","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","00173085910","BREO ","INH 100-25","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","",""],["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":""}]}]}