{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   R CALLIS","gend":1,"add":"817 WATERVIEW PL APT 202","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1986-09-16","age":"","mstatus":"","insh":"1457768*01","cliId":"","pno":"757\/335-8875","cno":"","email":"","ename":"","eno":"","pphy":"PIPER, ALYSE Y PA","ppno":"757\/507-0305","pcpadd":"STE 300 1950 GLEN MITCHELL DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-0306","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F33.0","R11.2","R52.","F43.12","R21.","M79.89","H92.09","R09.81","R19.7","F41.0","F33.2","R11.0","J30.9","Z03.818","Z20.828","S90.121A","L73.8","L70.0","J34.89","H92.03","B37.9","M84.375A","M51.36","F41.9","F32.9","J32.9","Z23.","E01.0","M79.672","Z72.0","R22.0","M89.8X9"],"date":["2021-10-13","2020-01-23","2021-02-03","2021-02-03","2021-02-25","2020-06-07","2020-06-07","2021-01-15","2021-01-15","2021-01-15","2021-10-13","2021-10-13","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-07-19","2020-12-11","2020-12-11","2021-11-02","2021-11-02","2021-08-09","2019-10-21","2019-10-21","2019-10-31","2019-10-31","2019-01-25","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2019-10-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00781717250","AZELAIC","GEL 0.15","50","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","11527070442","SOD","PST 1.1-5%","100","Select","Select",""],["","49884030702","CLONAZEP","TAB 0.25MG","30","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00536117201","ACETAMIN","TAB 500MG","21","Select","Select",""],["","13668013610","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""]]}},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}