{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   M DARDEN","gend":1,"add":"1002 COQUINA CHASE","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1961-11-11","age":"","mstatus":"","insh":"3902579*01","cliId":"","pno":"757\/567-4587","cno":"757\/567-4587","email":"","ename":"","eno":"","pphy":"PALTING, JOHN KENNETH MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9171","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.4","G43.719","G44.1","G93.89","G50.8","R41.840","Z87.820","Z79.891","F32.9","F43.12","G47.09","E03.1","G44.211","G43.109","Z11.59","G43.919","F33.0","Z20.822","D48.5","F32.89","G90.8","Z12.11","L57.8","Z12.83","C44.329","C44.311","L57.0","L82.1"],"date":["2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-05-19","2021-11-01","2021-11-01","2021-11-02","2021-11-01","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2021-11-01","2021-08-05","2021-01-31","2021-06-15","2020-07-20","2020-11-11","2021-05-23","2021-06-15","2021-06-15","2021-08-03","2021-09-03","2021-11-15","2021-11-15"],"priorHcc":[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":[["","69315013501","IMIPRAM","50MG","60","Select","Select",""],["","67877024201","QUETIAPINE","25MG","120","Select","Select",""],["","59762372004","ALPRAZOLAM","0.5MG","-120","Select","Select",""],["","10702000801","OXYCODONE","15MG","120","Select","Select",""],["","00781518392","LEVOTHYROXIN","88MCG","-30","Select","Select",""],["","13668000810","ZOLPIDEM","10MG","30","Select","Select",""],["","69315090510","LORAZEPAM","1MG","90","Select","Select",""],["","68382080605","TRAZODONE","100MG","120","Select","Select",""],["","62332038231","TEMAZEPAM","30MG","30","Select","Select",""],["","62856041030","DAYVIGO","10MG","30","Select","Select",""],["","59630022230","SYMPROIC","0.2MG","30","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","10","Select","Select",""],["","67877043005","ARIPIPRAZOLE","2MG","28","Select","Select",""],["","52817033050","CYCLOBENZAPR","5MG","14","Select","Select",""],["","69547035302","NARCAN","","-2","Select","Select",""],["","29300012510","MELOXICAM","15MG","10","Select","Select",""],["","00006033530","BELSOMRA","20MG","30","Select","Select",""],["","31722077701","ACYCLOVIR","400MG","30","Select","Select",""],["","59676058005","JANSSEN","COVID-19","0","Select","Select",""],["","69315090510","LORAZEPAM ","1MG","90","Select","Select",""],["","10702000801","OXYCODONE ","15MG","120","Select","Select",""],["","13668000810","ZOLPIDEM ","10MG","30","Select","Select",""],["","68382080605","TRAZODONE ","100MG","120","Select","Select",""],["","59762372004","ALPRAZOLAM ","0.5MG","-120","Select","Select",""],["","69315013501","IMIPRAM ","50MG","60","Select","Select",""],["","67877024201","QUETIAPINE ","25MG","120","Select","Select",""],["","00781518392","LEVOTHYROXIN ","88MCG","30","Select","Select",""],["","59630022230","SYMPROIC ","0.2MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","10","Select","Select",""],["","00378401005","TEMAZEPAM ","15MG","60","Select","Select",""],["","62856041030","DAYVIGO ","10MG","30","Select","Select",""],["","00006033530","BELSOMRA ","20MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","52817033050","CYCLOBENZAPR ","5MG","14","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","30","Select","Select",""],["","29300012510","MELOXICAM ","15MG","10","Select","Select",""],["","31722077701","ACYCLOVIR ","400MG","30","Select","Select",""],["","67877043005","ARIPIPRAZOLE ","2MG","28","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0","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":""}]}]}