{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTEN   D FIELD","gend":1,"add":"8458 RADNOR RD","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1977-06-15","age":"","mstatus":"","insh":"5200342*01","cliId":"","pno":"757\/321-0805","cno":"757\/321-0805","email":"","ename":"","eno":"","pphy":"BADEMIAN, ROBERT L MD","ppno":"757\/261-5910","pcpadd":"SUITE 200A 850 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Kempsville","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"623-3858","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9969","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F98.8","E03.4","J03.90","Z20.828","R42.","Z00.00","J06.9","S63.8X1A"],"date":["2021-05-12","2021-11-15","2021-03-19","2021-03-19","2020-08-07","2021-11-15","2021-10-21","2021-09-30"],"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":[["","66993059702","AMPHET\/DEXTR","20MG ER","-30","Select","Select",""],["","65862017760","CEFDINIR","300MG","20","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","-12","Select","Select",""],["","59746012106","MECLIZINE","25MG","21","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","90","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","66993059702","AMPHET\/DEXTR ","20MG ER","30","Select","Select",""],["","59746012106","MECLIZINE ","25MG","21","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","65862017760","CEFDINIR ","300MG","20","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","90","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","13107005999","APAP\/CODEINE","300-30MG","15","Select","Select",""],["","59762219807","AZITHROMYCIN","250MG","-6","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","13107005999","APAP\/CODEINE ","TAB 300-30MG","15","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","51224002250","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","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":""}]}]}