{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ROBERT W ROLLINS","gend":0,"add":"3109 NIAGARA WAY","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1968-09-15","age":"","mstatus":"","insh":"4362144*01","cliId":"","pno":"757\/285-4215","cno":"757\/285-4215, ","email":"","ename":"","eno":"","pphy":"ONAYEMI, OLUSOLA K MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H04.123","E11.3311","E11.3292","H35.82","H35.351","H04.121","E11.21","Z79.4","E78.2","I10.","E11.59","F51.02","R45.4","I25.110","I25.10","Z98.61"],"date":["2020-11-13","2021-01-07","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2021-05-06","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-02-01","2020-11-11"],"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":[["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","50111056103","TRAZODONE","100MG","30","Select","Select",""],["","52817036000","METOPROL","25MG","18","Select","Select",""],["","68180059101","RAMIPRIL","10MG","18","Select","Select",""],["","67877041305","METFORMIN","500MG ER","72","Select","Select",""],["","00527163201","TRIAMT\/HCTZ","37.5-25","-90","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","66733082259","INSULIN","100\/ML","15","Select","Select",""],["","69097083305","SERTRALINE","25MG","-30","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}