{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIAH   S HOLMAN","gend":1,"add":"5533 BOUND BROOK CTS","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1999-11-08","age":"","mstatus":"","insh":"2183223*01","cliId":"","pno":"757\/495-9844","cno":"757\/495-9844","email":"","ename":"","eno":"","pphy":"MOHAN, RAVINDER MD","ppno":"757\/413-7600","pcpadd":"STE 301 5320 PROVIDENCE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":450016,"pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9067","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N64.4","F41.1","F33.9","F31.30","F41.9","J30.1","J30.81","J30.89","F33.2","O14.90","Z72.89","Z01.812","Z30.017","R10.2","B37.3","F91.3","F39.","V62.84","Z91.5","J45.909","R10.31","Z30.9","R11.0","Z32.02","J45.30","Z3A.17","J45.901"],"date":["2020-05-20","2020-06-23","2020-06-23","2020-11-19","2020-11-19","2021-10-18","2021-10-18","2021-10-18","2020-02-24","2020-02-04","2020-02-04","2020-02-24","2020-02-24","2020-01-21","2020-01-17","2020-02-24","2020-02-04","2020-02-03","2020-02-03","2020-02-03","2020-01-21","2020-02-17","2020-03-11","2020-01-16","2021-10-18","2021-09-16","2021-09-16"],"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":[["","16714036504","ELINEST ","","28","Select","Select",""],["","60505265301","TRAZODONE ","50MG","14","Select","Select",""],["","65862019301","FLUOXETINE ","20MG","14","Select","Select",""],["","62756018388","OXCARBAZEPIN ","150MG","60","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","13","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","30","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","00135057602","FLONASE ","50MCG","10","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","68462034690","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00781635587","MOMETASONE ","50MCG","17","Select","Select",""],["","00093598627","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","80681017000","VITAMIN ","50MCG","180","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","16714036504","ELINEST","","28","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","62756018388","OXCARBAZEPIN","150MG","28","Select","Select",""],["","65862019301","FLUOXETINE","20MG","14","Select","Select",""],["","60505265301","TRAZODONE","50MG","14","Select","Select",""],["","69097014260","ALBUTEROL","HFA","13","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","68462034690","LEVOCETIRIZI","5MG","30","Select","Select",""],["","00135057602","FLONASE","50MCG","10","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00781635587","MOMETASONE","50MCG","17","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","30","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","80681017000","VITAMIN","50MCG","180","Select","Select",""],["","59746017506","PREDNISONE","20MG","15","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10","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":""}]}]}