{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEANNA   A MCCARDELL","gend":1,"add":"2207 PINE SHORE CTS","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1986-12-16","age":"","mstatus":"","insh":"1840319*01","cliId":"","pno":"757\/633-6193","cno":"757\/633-6193","email":"","ename":"","eno":"","pphy":"STEWART, LEAH A NP","ppno":"757\/333-7625","pcpadd":"2017 PLEASURE HOUSE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/998-5514","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/318-6901","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z11.51","M54.2","M62.838","Z11.3","Z79.3","B86.","Z32.02","R87.612","N39.0","Z01.810","N87.9","Z86.79","R10.11","R87.619","L98.9","L81.9","F41.9","Z87.898","F19.94","R45.1","F10.21","F13.10","F12.20","F60.89","Z65.8","F15.90"],"date":["2021-04-30","2020-02-11","2020-12-15","2020-12-15","2021-04-30","2021-04-30","2020-09-01","2020-05-11","2020-05-11","2020-02-21","2020-07-01","2020-07-10","2020-07-01","2021-01-20","2020-06-02","2020-08-07","2020-08-07","2021-10-18","2020-08-07","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18"],"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":[["","62332000131","FAMOTIDINE","20MG","28","Select","Select",""],["","43598075205","BUPROPION ","150MG SR","30","Select","Select",""],["","65862001305","SERTRALINE ","100MG","30","Select","Select",""],["","68180088673","NIKKI ","3-0.02MG","28","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","16729008110","NALTREXONE ","50MG","30","Select","Select",""],["","00093542328","GIANVI ","3-0.02MG","84","Select","Select",""],["","62332000131","FAMOTIDINE ","20MG","28","Select","Select",""],["","68462072029","DROSPIRENONE ","ETHY EST","84","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","6","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","33342006707","OLANZAPINE ","2.5MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","45802026937","PERMETHRIN ","5%","120","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","135","Select","Select",""],["","29300046810","CLONIDINE ","0.1MG","30","Select","Select",""],["","68180088673","NIKKI","3-0.02MG","28","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","68180035302","SERTRALINE","100MG","45","Select","Select",""],["","43598075205","BUPROPION","150MG SR","30","Select","Select",""],["","16729008110","NALTREXONE","50MG","30","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","9","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","00093542328","GIANVI","3-0.02MG","84","Select","Select",""],["","68462072029","DROSPIRENONE","ETHY EST","84","Select","Select",""],["","33342006707","OLANZAPINE","2.5MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","5","Select","Select",""],["","45802026937","PERMETHRIN","5%","120","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","68180031909","BUPROPN","150MG XL","135","Select","Select",""],["","29300046810","CLONIDINE","0.1MG","30","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","10","Select","Select",""],["","60505265301","TRAZODONE ","TAB 50MG","15","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","",""],["No","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":""}]}]}