{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PHILLIP DEL NERO","gend":0,"add":"4973 ADELIA DR","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1958-03-27","age":"","mstatus":"","insh":"2001242*01","cliId":"","pno":"315\/299-2655","cno":"315\/299-2655","email":"","ename":"","eno":"","pphy":"STEWART, LEAH A NP","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"315\/299-2655","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/318-6901","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K80.70","Z95.2","Z79.01","Z51.81","I49.3","I48.91","I48.20","I35.1","M16.12","M25.562","M25.552","Z95.4","Z98.890","K83.1","K63.5","R74.9","K81.0","Z00.00","K91.89","Z90.49","I25.10","I50.22","Z95.810","I34.1","Z79.51","Z79.899","Z88.2","Z88.8","Z82.49","R10.11","I48.19","I42.8","K80.50","E78.00","E55.9","I73.9","G58.9","K81.1","L76.82","I10.","Z12.5","K81.2","E78.5","N40.0","G89.29","M54.9","I35.0","I71.2","I34.0","I48.11","N28.1","K80.20","Z01.818","Z11.59","R60.0","Z01.812","Z01.810","Z20.828","R94.31","I42.9","I50.9","Z95.1","Z12.11","I48.21","I48.0","Z47.1","Z96.652","M25.652","Z96.642"],"date":["2020-01-23","2021-11-12","2021-11-12","2021-11-12","2021-09-17","2021-09-21","2020-10-22","2021-09-17","2021-10-15","2020-10-08","2021-10-20","2021-04-06","2021-09-21","2020-07-21","2020-01-07","2020-01-07","2020-07-24","2021-03-22","2020-07-28","2021-09-21","2021-10-15","2021-10-15","2021-09-21","2020-12-08","2020-07-28","2021-09-21","2021-09-21","2021-09-21","2020-12-08","2020-07-28","2021-09-17","2021-09-21","2021-03-19","2021-03-19","2020-10-19","2020-02-20","2020-02-20","2020-07-21","2020-07-28","2020-10-19","2021-10-19","2020-07-21","2021-10-15","2020-12-08","2020-07-21","2020-07-21","2020-10-15","2020-10-15","2020-10-15","2021-09-17","2020-01-23","2020-02-07","2021-09-10","2020-07-18","2020-09-14","2021-09-13","2021-09-13","2020-12-05","2021-09-13","2020-12-08","2020-12-08","2020-12-08","2021-05-23","2021-09-22","2021-10-15","2021-09-21","2021-09-21","2021-10-21","2021-10-21"],"priorHcc":["",null,null,null,null,null,"",null,null,"",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":[["","49884011701","AMILORIDE","5MG","30","Select","Select",""],["","00115166202","PROPRANOLOL","80MG","60","Select","Select",""],["","00115981103","DIGOXIN","0.125MG","30","Select","Select",""],["","00781342868","ENOXAPARIN","80\/0.8ML","8","Select","Select",""],["","00093171601","WARFARIN","4MG","-45","Select","Select",""],["","00536379001","VITAMIN","2000UNIT","60","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","15","Select","Select",""],["","45802086866","POLYETH","3350 NF","14","Select","Select",""],["","45802048678","DOCUSATE","100MG","28","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","49884011701","AMILORIDE ","5MG","30","Select","Select",""],["","00115981103","DIGOXIN ","0.125MG","30","Select","Select",""],["","00093171601","WARFARIN ","4MG","-45","Select","Select",""],["","00536379001","VITAMIN ","2000UNIT","60","Select","Select",""],["","00115166202","PROPRANOLOL ","80MG","60","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","20","Select","Select",""],["","00955100810","ENOXAPARIN ","80\/0.8ML","8","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","45802048678","DOCUSATE ","100MG","28","Select","Select",""],["","45802086866","POLYETH ","3350 NF","14","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","15","Select","Select",""],["","45802014167","CICLOPIROX ","8%","7","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","65162062711","TRAMADOL","50MG","40","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","-28","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","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":""}]}]}