{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE   LEE VANWAGNER","gend":1,"add":"4713 DERMOTT ST","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1961-12-06","age":"","mstatus":"","insh":"6801773*02","cliId":"","pno":"757\/879-2210","cno":"757\/879-2210","email":"","ename":"","eno":"","pphy":"PALTING, ARLENE MD","ppno":"757\/983-1777","pcpadd":"STE 101 213 RIVER WALK PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":700507,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Riverwalk","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/641-2536","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":["J40.","F17.200","H25.811","F41.1","F90.2","Z00.00","H25.812","Z12.31","Z01.818","H26.9","F41.9","K21.9","E78.2","E66.9","Z12.39","Z12.11","F41.8","F90.9","R22.0","R05.","Z13.820","R06.2","Z78.0","R03.0","H02.832","H02.835","Z23.","L91.8","H25.13","H25.819","H25.813","H53.043"],"date":["2020-01-02","2021-05-13","2020-10-01","2021-07-15","2021-07-15","2021-01-07","2020-09-17","2021-01-06","2020-08-25","2020-08-25","2021-01-07","2021-05-13","2021-05-13","2021-05-13","2021-01-06","2020-10-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2020-09-30","2020-09-30","2021-01-07","2020-01-29","2020-08-03","2020-09-16","2020-08-11","2020-08-11"],"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":[["","64380071306","BENZONATATE ","200MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59417010310","VYVANSE ","30MG","30","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","-30","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","-30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","35573041830","ATOMOXETINE ","40MG","60","Select","Select",""],["","00591544305","PREDNISONE ","20MG","12","Select","Select",""],["","08373747800","OPTICHAMBER ","DIAMOND","-1","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","-30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","08373917700","VALVD ","CHAMBER","1","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":""}]}]}