{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH   N WASHBURN","gend":1,"add":"3625 DUPONT CIR","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1957-11-26","age":"","mstatus":"","insh":"8132534*01","cliId":"","pno":"757\/435-3770","cno":"757\/435-3770","email":"","ename":"","eno":"","pphy":"PEARMAN, STEVEN D MD","ppno":"757\/252-9800","pcpadd":"1380 TUSCANY DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":117382,"pcpname":"SMG - Sentara Family Medicine Physicians - Nimmo","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9793","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","M26.9","L30.9","I10.","E78.2","R73.01","E03.4","E55.9","M79.672","M25.572","Z00.00","M81.0","M79.644","L03.818","K21.9","Z12.39","F32.9","F51.01","Z86.19","L57.8","L81.2","D48.5","H53.8","H25.13","Z20.828","R53.83","M79.10","R11.2","Z12.31","H43.812","M25.571","M76.60","Z23.","Z01.411","N95.2","R05.","M10.9","R79.89","R06.83","S93.401A","M76.71","R06.81","R40.0","Z01.419","N30.00","N10.","R30.0","R10.9","N39.0","N85.9","Z87.440","Z87.442","Z87.448","Z13.820","D25.1","D25.9"],"date":["2021-06-21","2020-01-29","2020-02-04","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2020-08-03","2020-08-03","2021-03-09","2021-11-08","2021-01-22","2020-01-28","2021-01-22","2020-03-05","2021-03-09","2021-03-09","2021-01-22","2020-07-09","2020-07-09","2020-07-09","2020-07-14","2020-08-17","2021-03-01","2021-01-07","2021-01-07","2021-01-07","2021-11-17","2021-02-17","2020-09-24","2020-09-23","2020-09-23","2020-10-16","2021-10-08","2021-01-22","2021-09-08","2021-01-22","2020-09-29","2020-09-24","2020-09-24","2020-09-29","2020-09-29","2021-11-17","2021-07-28","2021-08-16","2021-09-08","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-08","2021-11-17","2021-11-17","2021-10-08"],"priorHcc":["","","","","","","","","","","",null,"","","","","","","","","","","","","","","","",null,"","","","","",null,"","","","","","","","",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":[["","68180046907","LOVASTATIN","40MG","90","Select","Select",""],["","68180071909","AMLODIPINE","2.5MG","90","Select","Select",""],["","00093227534","AMOX\/K","875-125","20","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","-90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","43598075201","BUPROPION","150MG SR","90","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","68462030201","INDOMETHACIN","50MG","15","Select","Select",""],["","61442011201","ACYCLOVIR","400MG","270","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","68180046907","LOVASTATIN ","40MG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","90","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00093227534","AMOX\/K ","875-125","20","Select","Select",""],["","43598075201","BUPROPION ","150MG SR","90","Select","Select",""],["","61442011201","ACYCLOVIR ","400MG","270","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","90","Select","Select",""],["","68462030205","INDOMETHACIN ","50MG","-15","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","20","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","00046087221","PREMARIN","0.625MG","-30","Select","Select",""],["","00046087221","PREMARIN ","CRE 0.625MG","-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","",""],["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":""}]}]}