{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEAN   NICOLE WATSON","gend":1,"add":"3716 BEACON LN","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1979-07-03","age":"","mstatus":"","insh":"7735324*01","cliId":"","pno":"757\/375-6810","cno":"757\/375-6810","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":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/995-1714, ","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":["F90.0","F41.1","F33.1","N76.0","Z20.828","L29.3","I10.","M79.675","J30.89","F41.9","Z01.419","Z12.39","Z12.4","J32.9","J40.","R87.810","Z32.02","Z12.31","R10.32","E78.5","Z13.1","Z00.00","Z13.29","R05.","E03.9","M79.672","Z71.3","K90.0","Z68.41"],"date":["2021-09-20","2021-04-05","2021-04-05","2021-01-29","2020-11-20","2021-01-29","2021-08-27","2020-07-27","2020-07-27","2020-07-27","2020-10-14","2020-10-14","2020-10-14","2020-11-20","2020-11-20","2020-11-10","2020-11-06","2021-08-05","2020-10-29","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-07-30","2021-08-27","2021-09-14","2021-08-27","2021-08-27","2021-08-27"],"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":[["","50111043401","TRAZODONE ","100MG","60","Select","Select",""],["","23155000810","HYDROCHLOROT ","25MG","30","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","30","Select","Select",""],["","65862023060","LAMOTRIGINE ","200MG","60","Select","Select",""],["","65862020190","LOSARTAN ","25MG","30","Select","Select",""],["","42806033901","AMPHET\/DEXTR ","5MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","20","Select","Select",""],["","59762371901","ALPRAZOLAM ","0.25MG","60","Select","Select",""],["","51862088403","CAMILA ","0.35MG","84","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","65862092585","INCASSIA ","0.35MG","84","Select","Select",""],["","68462030529","NORETHINDRON ","0.35MG","-84","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","118","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","51672126302","NYSTAT\/TRIAM ","","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00143312601","DICYCLOMINE ","10MG","30","Select","Select",""],["","67877057505","BENZONATATE ","200MG","21","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","65862023060","LAMOTRIGINE","200MG","60","Select","Select",""],["","00378180010","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","50111043401","TRAZODONE","100MG","60","Select","Select",""],["","13668001105","CITALOPRAM","40MG","30","Select","Select",""],["","65862020190","LOSARTAN","25MG","30","Select","Select",""],["","42806033901","AMPHET\/DEXTR","5MG","-30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","20","Select","Select",""],["","59762371901","ALPRAZOLAM","0.25MG","60","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","51862088403","CAMILA","0.35MG","84","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","-84","Select","Select",""],["","65862092585","INCASSIA","0.35MG","-84","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","118","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","51672126302","NYSTAT\/TRIAM","","-60","Select","Select",""],["","00143312601","DICYCLOMINE","10MG","30","Select","Select",""],["","67877057505","BENZONATATE","200MG","21","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","00378180010","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","62175061846","PANTOPRAZOLE","20MG","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":[[["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":""}]}]}