{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JILL MARIANO","gend":1,"add":"1736 LOVETTS POND LN","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1968-08-15","age":"","mstatus":"","insh":"7901402*02","cliId":"","pno":"757\/631-7796","cno":"757\/631-7796","email":"","ename":"","eno":"","pphy":"CURULLA, RICHARD MD","ppno":"757\/507-0900","pcpadd":"STE 202 1925 GLENN MITCHELL D","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Princess Anne","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"491-7337","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":["I87.2","Z78.9","M79.661","Z20.828","G56.22","Z20.822","H57.12","M17.12","M25.562","M22.8X2","M70.32","Z12.31","T15.92XA","L03.114","J45.40","M79.602","M25.512","M23.92","M25.862","M76.892","T14.90XA","J44.9","Z03.818","Z11.52","J45.909","K21.9","J30.9"],"date":["2020-01-29","2020-01-29","2020-01-29","2020-12-23","2021-02-17","2021-02-18","2020-03-16","2021-02-02","2020-12-22","2021-02-02","2020-12-24","2021-03-22","2020-03-15","2020-12-20","2020-05-11","2020-12-26","2021-01-18","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-01-22","2020-12-02","2021-02-18","2021-10-18","2021-10-18","2021-10-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00597010061","SPIRIVA","2.5MCG","4","Select","Select",""],["","00115168974","BUDESONIDE","0.5MG\/2","120","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00173068220","VENTOLIN","","54","Select","Select",""],["","66993001968","ALBUTEROL","HFA","54","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","63402091164","BROVANA","15MCG","120","Select","Select",""],["","53489011905","DOXYCYCL","100MG","-14","Select","Select",""],["","24208039915","IPRATROPIUM","0.06%","45","Select","Select",""],["","00597015561","STIOLTO","2.5-2.5","4","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00378064205","PREDNISONE","20MG","18","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","4","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","24208039915","IPRATROPIUM ","0.06%","45","Select","Select",""],["","00173068220","VENTOLIN ","","-54","Select","Select",""],["","00378699152","ALBUTEROL ","0.63MG\/3","-225","Select","Select",""],["","00115168974","BUDESONIDE ","0.5MG\/2","360","Select","Select",""],["","63402091164","BROVANA ","15MCG","360","Select","Select",""],["","00597015561","STIOLTO ","2.5-2.5","4","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","00378064205","PREDNISONE ","20MG","18","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","70436015157","ARFORMOTEROL ","15\/2ML","360","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","70436015157","ARFORMOTEROL","15\/2ML","360","Select","Select",""],["","00173089310","TRELEGY","ELLIPTA","180","Select","Select",""],["","00173089310","TRELEGY ","AER ELLIPTA","-180","Select","Select",""],["","80777027398","MODERNA ","INJ 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":""}]}]}