{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL  J ADAMOV","gend":0,"add":"5632 TENDRIL LAST APT B","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1973-12-14","age":"","mstatus":"","insh":"1500272*01","cliId":"","pno":"757\/977-7286","cno":"757\/977-7286","email":"","ename":"","eno":"","pphy":"GATA JR, RENATO G MD","ppno":"757\/395-1900","pcpadd":"5460 WESLEYAN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Wesleyan","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/381-2094","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/995-7373","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.9","R07.9","R29.898","Z72.0","E11.29","I21.4","E11.65","R80.9","Z79.4","M25.512","I10.","E66.01","L03.031","R26.89","M25.532","E78.00","G89.29","L73.9","Z11.52","J45.909","Z12.5","R20.2","Z12.11","B35.1","E11.59","I15.2","M19.032","G56.02","G81.94"],"date":["2021-08-20","2021-02-20","2021-02-20","2021-02-20","2021-07-27","2021-03-12","2021-07-27","2021-07-27","2021-07-27","2021-03-03","2021-07-27","2021-06-01","2021-06-01","2021-07-19","2021-07-27","2021-07-27","2021-07-27","2021-01-05","2021-01-19","2021-01-19","2020-07-30","2021-01-05","2021-01-05","2021-06-09","2021-07-16","2021-07-16","2021-08-20","2021-08-20","2021-08-20"],"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":[["","00002879959","HUMALOG ","100\/ML","90","Select","Select",""],["","45963070911","METOPROL ","25MG ER","10","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00002822259","INSULIN ","100\/ML","27","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","68180098201","LISINOPRIL ","30MG","41","Select","Select",""],["","00088222033","LANTUS ","100\/ML","30","Select","Select",""],["","00378718705","METFORMIN ","1000MG","180","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","16729000617","SIMVASTATIN ","40MG","90","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","90","Select","Select",""],["","49884072703","DOXYCYC ","100MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","12","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}