{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHEA GAYNOR","gend":1,"add":"733 CASON LN","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1983-02-04","age":"","mstatus":"","insh":"4434838*01","cliId":"","pno":"757\/930-9458","cno":"757\/930-9458","email":"","ename":"","eno":"","pphy":"ALBALA, TODD MD","ppno":"757\/395-6630","pcpadd":"1080 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117381,"pcpname":"SMG - Sentara Family Medicine Physicians - 1080 Bldg","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","S46.819A","M54.2","R51.","V49.40XA","I42.8","I50.22","I10.","E66.01","F17.200","I07.1","I34.0","M54.5","F34.89","F43.12","F41.1","Z59.0","F51.04","Z79.899","Z71.89","G43.009","Z68.41","M12.9","NO DATA","M79.2","M62.838","G89.29","E55.9","Z30.42","M62.830","D64.9","M22.2X1","M22.2X2","R07.89","I51.7","H40.1131"],"date":["2021-02-05","2020-02-11","2020-03-03","2020-02-11","2020-02-11","2020-12-29","2020-12-29","2021-01-25","2020-12-29","2020-02-18","2020-02-18","2020-02-18","2020-12-01","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-06-05","2020-06-05","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-06-03","2021-01-25","2020-02-14","2020-10-29","2020-11-09","2020-11-09","2020-12-29","2020-02-18","2020-07-03"],"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":[["","00172392670","DIAZEPAM ","5MG","12","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","2","Select","Select",""],["","31722052001","HYDRALAZINE ","25MG","270","Select","Select",""],["","31722070110","LOSARTAN ","50MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","18","Select","Select",""],["","65862014505","CARVEDILOL ","25MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","65862066330","ARIPIPRAZOLE ","10MG","30","Select","Select",""],["","29300011201","LAMOTRIGINE ","100MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","59762453701","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","60","Select","Select",""],["","00527133001","BACLOFEN ","10MG","60","Select","Select",""],["","69238117109","DOXEPIN ","50MG","90","Select","Select",""],["","61874013030","VRAYLAR ","3MG","30","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","30","Select","Select",""],["","65862052790","VENLAFAXINE ","37.5 ER","60","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","42043013109","NARATRIPTAN ","2.5MG","12","Select","Select",""],["","68180037703","LOSARTAN","50MG","30","Select","Select",""],["","65862066330","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","29300011201","LAMOTRIGINE","100MG","30","Select","Select",""],["","31722052001","HYDRALAZINE","25MG","90","Select","Select",""],["","61314054701","LATANOPROST","0.01%","2","Select","Select",""],["","65862014505","CARVEDILOL","25MG","180","Select","Select",""],["","00172392670","DIAZEPAM","5MG","12","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","60","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","18","Select","Select",""],["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","68180072003","AMLODIPINE","5MG","24","Select","Select",""],["","53746051105","SPIRONOLACT","25MG","22","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","65862052790","VENLAFAXINE","37.5 ER","60","Select","Select",""],["","42043013109","NARATRIPTAN","2.5MG","12","Select","Select",""],["","69238117009","DOXEPIN","25MG","60","Select","Select",""],["","00527133001","BACLOFEN","10MG","60","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","55111018015","TIZANIDINE","4MG","30","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","",""],["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":""}]}]}