{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE DUNBAR","gend":1,"add":"313 HARMONY SQ","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1950-06-24","age":"","mstatus":"","insh":"20038483*01","cliId":"","pno":"491-0256","cno":"","email":"","ename":"","eno":"","pphy":"ALBALA, NATALIE L MD","ppno":"757\/395-6630","pcpadd":"1080 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - 1080 Bldg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","E78.2","E11.9","J32.9","Z68.41","J30.1","I10.","G47.33","J45.909","Z12.39","E28.39","Z99.89","H16.223","J18.9","E11.40","Z11.59","J45.30","J01.40","Z20.822","Z91.14","L84.","J00.","Z01.84","J01.00","Z20.828","R05.9","Z12.11","M79.604","NO DATA","S33.5XXA"],"date":["2020-01-20","2022-01-07","2021-03-09","2020-01-20","2022-01-07","2021-07-01","2022-01-07","2022-01-07","2022-01-07","2020-01-20","2020-01-20","2022-01-07","2022-11-15","2020-04-28","2022-01-07","2021-07-01","2021-07-01","2022-08-05","2022-08-05","2020-03-10","2020-02-06","2021-04-16","2021-04-16","2022-11-18","2022-06-25","2022-06-25","2022-01-07","2021-12-15","2022-11-15","2022-11-18"],"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":[]},{"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":[["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00006057561","JANUMET","TAB 50-500MG","180","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","62332008390","VALSART\/HCTZ","TAB 320-25MG","90","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","16714049401","AMOX\/K","TAB 500-125","20","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00023916330","RESTASIS","EMU 0.0005","90","Select","Select",""],["","60505620202","CYCLOSPORINE","EMU 0.05% OP","180","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","31722054301","INDOMETHACIN","CAP 50MG","20","Select","Select",""],["","69238115403","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","64679096105","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","53885099425","ONETOUCH","TES ULTRA","25","Select","Select",""],["","60505258009","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","54092060601","XIIDRA","DRO 0.05","60","Select","Select",""],["","00065427325","PAZEO","DRO 0.007","2","Select","Select",""],["","68180046707","LOVASTATIN","TAB 10MG","90","Select","Select",""],["","69543025204","VIRTUSSIN","SOL 100-10\/5","118","Select","Select",""],["","00527193006","CLARITHROMYC","TAB 500MG ER","14","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":""}]}]}