{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDDIE   L LUSK","gend":0,"add":"612RIVERS REACH","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1960-03-10","age":"","mstatus":"","insh":"1458992*01","cliId":"","pno":"757\/961-4034","cno":"757\/961-4034","email":"","ename":"","eno":"","pphy":"WOODS, DAVID W MD","ppno":"","pcpadd":"#100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":101283,"pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/944-8875","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-9029","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","R07.81","R10.84","K81.0","E11.42","E78.00","E78.2","I10.","E66.9","R10.13","E11.65","R11.2","A41.9","R65.21","K83.01","J96.01","E87.2","I25.10","N17.9","R07.9","R40.4","R41.0","K82.8","K83.8","R17.","R10.9","Z46.59","R78.81","G93.41","M20.12","M20.11","S90.212D","S90.211D","L60.0","L60.2","B35.1","L60.1","Z79.4","E29.1","E11.21","K21.9","N52.9","G47.33","F17.200","N18.31","E11.3293","E11.39","H25.13","H25.013","S90.212A","S90.211A","A41.51","K85.90","I21.A1","E87.1","E87.4","I13.0","I50.32","A41.59","Z20.822","I25.2","D69.6","I11.0","I50.9","F17.210","Z95.5","Z88.5","R11.11","R74.01","N18.30","K81.9","I25.810","E11.22","I95.89","N17.0","A41.4","I95.9","D53.9","G51.0","R29.810","L98.9","E11.9","Z85.9","R10.11","R06.02","T85.518A","Z90.49","K82.0","Z87.19","Z01.810","Z09."],"date":["2021-03-29","2021-03-29","2021-08-18","2021-09-28","2021-05-28","2021-05-11","2021-05-28","2021-11-01","2021-05-28","2021-08-15","2021-08-15","2021-08-15","2021-08-26","2021-08-26","2021-08-16","2021-08-26","2021-08-16","2021-11-05","2021-08-26","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-09-28","2021-08-23","2021-08-19","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-06-17","2020-06-17","2020-06-22","2020-06-17","2021-08-26","2021-05-28","2021-05-28","2021-08-22","2021-05-28","2021-05-28","2021-11-01","2021-08-26","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2020-05-07","2020-05-07","2021-08-26","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-17","2021-08-16","2021-08-16","2021-10-18","2021-08-16","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-08-15","2021-08-26","2021-08-17","2021-10-04","2021-08-22","2021-08-26","2021-08-22","2021-08-22","2021-08-26","2021-08-26","2021-08-26","2020-04-01","2020-04-01","2021-03-29","2021-10-18","2021-08-12","2021-08-17","2021-08-17","2021-10-18","2021-10-18","2021-09-28","2021-09-28","2021-11-01","2021-11-01"],"priorHcc":["","","",null,"","","",null,"","","","","","","","","",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","",null,"",null,null,null,null,null,"","","",null,"","","","","","","","","","",null,"","","",null,null,null,null,null,null]}},{"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":[["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","68645055354","LISINOPRIL","20MG","90","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","65862007930","TERBINAFINE","250MG","30","Select","Select",""],["","31722094201","HYDROCO\/APAP","7.5-325","16","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","21","Select","Select",""],["","16714066202","GABAPENTIN","300MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00591352430","TESTOSTERONE","1%(50MG)","150","Select","Select",""],["","55111064530","OMEPRAZOLE","40MG","30","Select","Select",""],["","29033000305","SUCRALFATE","1GM","30","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","20","Select","Select",""],["","00245021211","MIDODRINE","5MG","15","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","20","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","68645055354","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","65862007930","TERBINAFINE ","TAB 250MG","-30","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","7","Select","Select",""],["","31722094201","HYDROCO\/APAP ","TAB 7.5-325","16","Select","Select",""],["","16714066202","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","21","Select","Select",""],["","00591352430","TESTOSTERONE ","GEL 1%(50MG)","150","Select","Select",""],["","29033000305","SUCRALFATE ","TAB 1GM","30","Select","Select",""],["","55111064530","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","00245021211","MIDODRINE ","TAB 5MG","15","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","30","Select","Select",""],["","58657067601","CIPROFLOXACN ","TAB 500MG","20","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}