{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA   L WILLIAMS","gend":1,"add":"1008 ALCON CT","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1985-02-10","age":"","mstatus":"","insh":"1177414*01","cliId":"","pno":"757\/635-4601","cno":"757\/635-4601","email":"","ename":"","eno":"","pphy":"ALBALA, TODD MD","ppno":"757\/395-6630","pcpadd":"1080 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117381,"pcpname":"SMG - Sentara Family Medicine Physicians - 1080 Bldg","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.1","F41.0","F90.0","J02.9","R09.89","Z30.431","Z00.00","R79.89","Z83.49","E78.2","Z20.822","G43.009","J45.21","J45.901","Z87.01","F17.200"],"date":["2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-01-09","2020-03-13","2020-12-10","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2020-03-13","2020-03-13","2020-03-13"],"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":[["","00173068220","VENTOLIN ","","18","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","8","Select","Select",""],["","59746017306","PREDNISONE ","10MG","43","Select","Select",""],["","00173069500","ADVAIR ","100\/50","60","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","60","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","12","Select","Select",""],["","52544008001","FIORICET ","","12","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59746017306","PREDNISONE","10MG","43","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","60","Select","Select",""],["","00173069500","ADVAIR","100\/50","60","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","12","Select","Select",""],["","52544008001","FIORICET","","12","Select","Select",""],["","59310057922","PROAIR","","8","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}