{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASON PILCHER","gend":0,"add":"9531 SHERWOOD PL","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1983-02-03","age":"","mstatus":"","insh":"1459136*01","cliId":"","pno":"757\/588-7730","cno":"757\/588-7730","email":"","ename":"","eno":"","pphy":"SOKOL, RICHARD A MD","ppno":"757\/252-9150","pcpadd":"SUITE 810 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":101207,"pcpname":"SMG - Sentara Family Medicine Physicians - Fort Norfolk","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/981-4181","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/252-9161","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","H53.9","R51.9","J34.9","F17.210","Z88.8","Z91.09","R20.0","M18.11","F32.9","F41.9","Z79.899","Z91.048","M18.9","R19.4","R25.2","M79.10","G47.09","T43.225A","F31.9","E78.5","R45.1","R06.02","R35.0","R31.29","R10.9","Z72.0","F32.1","M79.644","M65.311","Z01.812","Z20.822","Z01.818","E29.0","R10.2","N52.9","M19.042","M19.041","Z84.1","Z82.0","M19.031","Z01.810","E29.1","R31.1","R35.1","Z20.828","G47.00","R52.","T44.7X5A","R09.89","N32.81","R09.81","J31.0","G47.33","Z00.01"],"date":["2021-03-26","2021-01-26","2021-01-26","2021-01-26","2021-06-28","2021-06-28","2021-01-26","2021-01-26","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-06-28","2021-06-28","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2020-12-23","2021-03-26","2021-01-25","2021-01-26","2021-07-21","2021-04-23","2021-06-11","2021-06-25","2021-06-25","2021-06-25","2021-03-16","2021-03-16","2021-08-18","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-04-23","2021-06-15","2021-08-18","2021-08-18","2021-04-01","2020-12-17","2021-03-24","2021-03-24","2021-03-24","2020-12-17","2021-08-18","2021-09-02","2021-09-02","2021-09-02","2021-09-02"],"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":[["","68382025601","OXYBUTYNIN ","10MG ER","-30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","","12","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","65862001205","SERTRALINE ","50MG","90","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","65862001205","SERTRALINE","50MG","90","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","","12","Select","Select",""],["","68382025601","OXYBUTYNIN","10MG ER","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","-16","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","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","",""],["No","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":""}]}]}