{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL MARSHALL","gend":0,"add":"PO BOX 41397","city":"NORFOLK","state":"VA","zip":"23541-9998","dob":"1965-12-06","age":"","mstatus":"","insh":"1190949*01","cliId":"","pno":"757\/718-7318","cno":"757\/718-7318","email":"","ename":"","eno":"","pphy":"TUANQUIN GONZALEZ, LEILANIE C MD","ppno":"757\/261-5910","pcpadd":"SUITE 200A 850 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":450005,"pcpname":"SMG - Sentara Internal Medicine Physicians - Kempsville","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9970","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.01","Z12.5","B34.9","Z20.828","R09.02","D69.6","R82.2","R74.8","Z46.82","U07.1","J12.82","J98.4","J96.01","N17.9","N18.9","J96.02","G93.40","J45.909","N18.2","L89.312","K85.00","E86.0","E87.0","M79.641","R06.03","J18.9","E87.1","G93.41","Z71.89","Z51.5","R06.02","R07.9","R91.8","R11.2","R19.7","R79.1","J12.9","Z86.19","Z12.11","R11.0","B33.8","J96.91","I50.9","R41.82","G93.9","Z87.01","E07.1","E78.49","R20.2","Z00.00","F41.9","M79.631","I36.1","F32.9","K21.00","I10.","D64.9","J32.9","J45.998","J96.90","J96.21","R49.0","R94.31","N20.0","K85.90","N17.0","A41.9","R45.851","Z99.11","E88.09","Z79.899","Z13.228","E03.9","E55.9","Z20.822","R79.89","K82.8"],"date":["2020-06-05","2020-06-05","2021-02-01","2021-01-28","2021-02-06","2021-03-02","2021-02-04","2021-02-24","2021-02-17","2021-04-07","2021-04-07","2021-04-01","2021-03-02","2021-02-24","2021-02-24","2021-02-24","2021-02-26","2021-04-07","2021-04-09","2021-04-07","2021-02-04","2021-02-04","2021-02-05","2021-08-20","2021-02-18","2021-04-01","2021-02-17","2021-02-23","2021-02-23","2021-02-23","2021-03-09","2021-02-04","2021-02-14","2021-02-18","2021-02-04","2021-02-05","2021-02-06","2021-02-06","2020-08-31","2021-02-03","2021-02-03","2021-02-15","2021-02-15","2021-02-20","2021-02-20","2021-02-20","2021-04-06","2021-08-20","2021-04-06","2021-04-08","2021-03-03","2021-05-04","2021-02-08","2021-03-09","2021-03-09","2021-04-09","2021-04-22","2020-06-15","2020-06-15","2021-02-06","2021-02-15","2021-02-15","2021-02-17","2021-02-24","2021-02-24","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-08-13","2021-08-13","2021-08-20","2021-02-04","2021-02-15","2021-02-15"],"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":[["","00173068220","VENTOLIN","","-18","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","-16","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","70010010810","GABAPENTIN","100MG","30","Select","Select",""],["","00536106210","STOOL","100MG","30","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","15","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","40","Select","Select",""],["","57664037713","TRAMADOL","50MG","14","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","60505132101","MIDODRINE","5MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","14","Select","Select",""],["","45802005935","NYSTATIN","100000","15","Select","Select",""],["","43547028010","ESCITALOPRAM","5MG","30","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00591024001","LORAZEPAM","0.5MG","10","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00173068220","VENTOLIN ","","-18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","20","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","30","Select","Select",""],["","00591024001","LORAZEPAM ","0.5MG","10","Select","Select",""],["","57664037713","TRAMADOL ","50MG","14","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00536106210","STOOL ","100MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","14","Select","Select",""],["","43547028010","ESCITALOPRAM ","5MG","30","Select","Select",""],["","45802005935","NYSTATIN ","100000","15","Select","Select",""],["","60505132101","MIDODRINE ","5MG","60","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","15","Select","Select",""],["","70010010810","GABAPENTIN ","100MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","40","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","69097015907","MELOXICAM","15MG","-30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","-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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}