{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOLLY   E BAKKER","gend":1,"add":"3409 VICTORIA DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1965-12-24","age":"","mstatus":"","insh":"20041121*01","cliId":"","pno":"757\/364-8922","cno":"757\/364-8922","email":"","ename":"","eno":"","pphy":"HAGGERTY, MARK DO","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":310023,"pcpname":"SMG - Sentara Family Medicine Physicians - Little Neck","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/816-4017","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S80.01XA","K74.60","L03.031","J01.00","S63.522A","F31.9","L03.114","M65.9","I24.9","F90.2","G89.4","F17.210","F41.8","K58.1","E78.2","F33.41","M48.02","E11.65","E55.9","NO DATA","G89.29","Z91.81","Z79.891","L03.90","R82.90","F39.","A41.9","R10.9","R07.9","F33.2","J20.9","F43.21","R73.9","M54.9","H91.90","L98.9","R10.11","L25.9","Z79.4","R07.81","F41.1","F51.01","F90.0","F33.1","I67.1","E21.1","M17.0","M54.16","M54.5","F31.30","Z87.891","E87.6","Z11.59","E87.2","M70.22","F90.9","J44.9","K21.9","Z20.828","Z79.82","Z79.51","S29.012A","S22.32XA","R77.8","J11.89","R51.","M79.602","R53.1","M54.6","J06.9","Z20.822","R07.89","R10.2","L70.5","Z71.9","R10.13"],"date":["2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2021-07-24","2020-08-27","2020-08-27","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-05-22","2021-04-03","2020-06-16","2020-06-16","2020-08-27","2020-08-27","2021-01-21","2020-08-27","2020-08-14","2021-07-23","2021-06-03","2020-03-13","2020-08-17","2020-08-23","2020-12-18","2020-12-18","2021-01-21","2021-04-03","2020-12-18","2021-07-24","2021-05-11","2021-06-03","2021-06-03","2021-06-03","2020-10-23","2021-01-21","2021-01-21","2021-01-21","2020-03-17","2021-04-03","2020-04-21","2020-08-22","2020-08-23","2020-08-22","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2021-03-06","2021-05-07","2021-07-24","2020-01-30","2020-08-11","2021-02-19","2021-02-19","2021-04-03","2021-02-25","2021-02-25","2021-05-27","2020-08-23","2021-01-12","2021-01-12","2021-03-09"],"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":[]},{"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":""}]}]}