{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   M MORSTAIN","gend":0,"add":"4832 OVERMAN AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1962-07-02","age":"","mstatus":"","insh":"9548351*01","cliId":"","pno":"757\/985-2758","cno":"757\/985-2758","email":"","ename":"","eno":"","pphy":"ANDERSON, ROBIN N MD","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/552-0936","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9772","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","E78.5","B35.1","K64.9","H26.9","H25.813","H16.223","H25.13","H25.041","H25.12","K64.0","Z86.010","S01.302A","S01.302D","H73.892","Z12.11","K57.30","R10.31","U07.1","Z01.818","H25.11","Z86.16","M19.90","F17.210","Z79.82","Z79.899","K62.5","F17.200","H25.9","Z72.0","Z01.812","K57.90","Z20.828","Z20.822","H90.3","H66.012","Z98.41","Z96.1","K21.9","R13.12","J31.2","H26.493","R09.89"],"date":["2021-02-11","2021-03-15","2020-06-25","2020-06-25","2020-06-25","2020-07-03","2020-07-03","2021-01-07","2020-12-18","2021-03-15","2020-08-14","2020-08-14","2020-01-20","2020-02-11","2020-02-11","2020-08-14","2020-08-14","2020-12-18","2021-01-14","2021-01-14","2021-02-15","2021-02-15","2021-02-15","2021-03-15","2021-03-15","2021-03-15","2020-08-14","2020-08-14","2020-12-28","2021-08-06","2021-03-11","2020-08-14","2021-01-20","2021-03-11","2020-02-28","2020-02-28","2021-03-15","2021-03-15","2021-09-03","2021-08-06","2021-08-06","2021-10-25","2021-08-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","8","Select","Select",""],["","54766072606","PRAMOSONE","2.50%","59","Select","Select",""],["","45802047253","HC","2.5-1%","48","Select","Select",""],["","63481052910","CORTISPORIN","","-10","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","00713031788","CICLOPIROX","8%","7","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00143980305","DOXYCYCL","100MG","11","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","63481052910","CORTISPORIN ","","10","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00065853302","CIPRODEX ","0.3-0.1%","-8","Select","Select",""],["","45802047253","HC ","2.5-1%","48","Select","Select",""],["","00713031788","CICLOPIROX ","8%","7","Select","Select",""],["","54766072606","PRAMOSONE ","2.50%","59","Select","Select",""],["","45802086802","POLYETH ","3350 NF","-238","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","11","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","90","Select","Select",""],["","57237004105","PENICILLN ","500MG","56","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","57237004105","PENICILLN","500MG","56","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","90","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":""}]}]}