{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES STEELE","gend":0,"add":"3524 GAMAGE DR TERRI THOMAS","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1962-09-08","age":"","mstatus":"","insh":"4388518*01","cliId":"","pno":"757\/632-5007","cno":"757\/632-5007","email":"","ename":"","eno":"","pphy":"PALTING, JOHN KENNETH MD","ppno":"757\/395-1300","pcpadd":"2859 VIRGINIA BEACH","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\/235-5473","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9171","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.10","M54.2","I25.2","C90.00","I25.10","F17.210","Z76.5","Z79.02","Z88.6","Z95.5","R20.8","Z00.00","Z23.","F17.200","E78.00","M54.12","I10.","Z20.822","Z11.52","M79.2","Z12.5","M25.512","G89.29","H53.143","H43.813","H52.03","H31.002","Z72.0","E78.2"],"date":["2020-07-20","2020-07-20","2021-02-18","2020-09-17","2021-02-18","2021-02-18","2020-07-20","2020-07-20","2020-07-20","2021-02-18","2020-07-20","2021-02-18","2020-09-17","2021-02-18","2021-02-18","2021-02-18","2020-11-30","2021-01-21","2021-01-21","2020-07-20","2020-05-12","2020-05-12","2020-05-12","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-11-02","2020-11-02"],"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":[["","70377003012","ATORVASTATIN ","80MG","90","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","59779027408","ASPIRIN ","81MG","90","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","00781569031","EZETIMIBE ","10MG","90","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","2","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00005197102","PREVNAR ","","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","60","Select","Select",""],["","59779027408","ASPIRIN","81MG","90","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","90","Select","Select",""],["","65162019050","NAPROXEN","500MG","60","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00781569031","EZETIMIBE","10MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","2","Select","Select",""],["","68382091634","METHYLPRED","4MG","21","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","60505476606","APO-VARENICL ","TAB 1MG","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}