{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VAN   W ALDRIDGE","gend":0,"add":"614 YORK ST APT 152","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1959-05-08","pno":"804\/210-6786","cno":"804\/210-6786","email":"","pphy":"MASSENGILL, CHRISTOPHER L MD","ppno":"","pcpadd":"STE 200 4374 NEW TOWN AVE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":130405,"pcpname":"SMG - Sentara Family Medicine Physicians - New Town","insh":"20022984*01","cliId":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/259-8797","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K52.9","R10.84","E11.9","I10.","E11.65","N40.1","E78.2","J96.10","J44.9","R19.02","R63.4","R35.0","K42.9","D17.1","Z72.0","E66.09","Z68.31","R19.5","H90.3","R68.81","R19.8","Z12.83","H91.93","Z12.11","I27.81","Z91.19","NO DATA","K44.9","Z71.6","K92.1","N40.0","R10.12","E66.9","Z01.89","Z12.5","Z79.4"],"date":["2020-10-02","2020-10-02","2020-10-02","2021-04-22","2021-04-22","2020-11-05","2021-04-22","2021-04-22","2021-04-22","2020-11-05","2020-12-07","2020-11-05","2021-05-06","2020-11-20","2021-05-06","2020-11-20","2020-11-20","2020-10-01","2020-03-03","2020-12-07","2020-12-07","2020-01-09","2020-01-09","2020-04-23","2020-01-09","2020-09-23","2021-05-06","2021-05-06","2021-05-06","2020-04-23","2020-04-23","2020-05-07","2020-03-03","2021-04-22","2021-04-22","2021-04-22"],"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":[["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","65862020190","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","00378932132","WIXELA ","AER 250\/50","60","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","70377000911","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","50924097110","SOFTCLIX ","MIS LANCETS","100","Select","Select",""],["","65702040810","ACCU-CHEK ","TES AVIVA PL","100","Select","Select",""],["","76385012810","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","21","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","16714065204","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","42","Select","Select",""],["","53885013610","ONETOUCH ","MIS LANCETS","100","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","59779044574","CVS ","DIS 14MG\/24H","28","Select","Select",""],["","66689000802","NYSTATIN ","SUS 100000","60","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","",""],["Yes","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":""}]}]}