{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHALON   T WHITFIELD","gend":1,"add":"6117 BRADFORD DR APT B","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"2003-06-07","age":"","mstatus":"","insh":"8742545*01","cliId":"","pno":"304\/902-0524","cno":"304\/902-0524","email":"","ename":"","eno":"","pphy":"WADDY, JAMES M MD","ppno":"757\/983-2200","pcpadd":"BLD A SUITE 207 3920 BRIDGE ROAD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":139537,"pcpname":"SMG - Sentara Family Medicine Physicians - BelleHarbour","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/983-2201","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.50","L20.89","J30.1","J30.89","K90.49","Z91.018","Z79.51","Z79.899","K59.01","K21.9","R15.1","E66.9"],"date":["2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-10","2020-03-10","2020-03-10","2020-03-10"],"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":[["","00536100901","FERROUS ","325MG","30","Select","Select",""],["","55111072530","MONTELUKAST ","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","30","Select","Select",""],["","45802091939","CETIRIZINE ","10MG","30","Select","Select",""],["","00536106229","STOOL ","100MG","30","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","00299391746","CETAPHIL ","MOISTURE","454","Select","Select",""],["","00904759082","FEROSUL ","325MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","45802000402","HYDROCORT ","2.50%","20","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","17","Select","Select",""],["","45802005535","TRIAMCINOLON ","0.10%","60","Select","Select",""],["","00904645760","DOK ","100MG","30","Select","Select",""],["","49348081705","ACID ","20MG","60","Select","Select",""],["","55111072530","MONTELUKAST","10MG","30","Select","Select",""],["","45802091939","CETIRIZINE","10MG","30","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00536106229","STOOL","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","45802000402","HYDROCORT","2.50%","20","Select","Select",""],["","00299391746","CETAPHIL","MOISTURE","454","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","60","Select","Select",""],["","00904759060","FEROSUL","325MG","30","Select","Select",""],["","00904645760","DOK","100MG","30","Select","Select",""],["","49348081705","ACID","20MG","60","Select","Select",""],["","59310057922","PROAIR","","17","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":""}]}]}