{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   T LOUDERMILK","gend":0,"add":"1901 ASHMONT DR","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1963-03-08","age":"","mstatus":"","insh":"1737155*01","cliId":"","pno":"757\/471-4104","cno":"757\/471-4104","email":"","ename":"","eno":"","pphy":"CHARLES, MICHAEL G MD","ppno":"757\/395-1700","pcpadd":"3745 HOLLAND RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":700505,"pcpname":"SMG - Sentara Family Medicine Physicians - Chimney Hill","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/471-1035","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","J44.1","E78.00","F17.210","E04.1","M54.16","M50.322","M47.812","M46.90","M48.02","J01.90","Z23.","M50.220","M50.222","M54.12","J41.1","M47.892","M79.602","N40.0","R49.0","J43.9","J38.3","K21.9","R69.","Z12.2","R91.8","Z90.49","J44.9","Z86.010"],"date":["2021-07-09","2020-07-10","2021-07-09","2021-07-16","2021-07-16","2021-07-09","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-06-30","2021-01-05","2021-02-02","2021-02-02","2021-02-02","2020-03-23","2021-01-20","2021-01-20","2021-07-09","2021-07-22","2021-07-09","2021-07-22","2021-07-22","2021-07-22","2021-07-16","2021-07-16","2021-07-16","2021-07-20","2021-07-20"],"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":[["","65862005390","SIMVASTATIN","40MG","90","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","6","Select","Select",""],["","00143924920","AMOX\/K","875-125","14","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69238131209","PREGABALIN","75MG","60","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","21","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","50228018005","GABAPENTIN","300MG","180","Select","Select",""],["","55111018015","TIZANIDINE","4MG","90","Select","Select",""],["","65862005390","SIMVASTATIN ","40MG","90","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","6","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","21","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","180","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69238131209","PREGABALIN ","75MG","60","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","55111064501","OMEPRAZOLE ","40MG","60","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":""}]}]}