{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" THOMAS M ASCHER","gend":0,"add":"1636 WAKEFIELD DR","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1962-09-09","age":"","mstatus":"","insh":"6381960*01","cliId":"","pno":"757\/460-1510","cno":"757\/460-1510, 757\/687-8570","email":"","ename":"","eno":"","pphy":"WOODS, DAVID W MD","ppno":"757\/363-6800","pcpadd":"#100 816 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23455-9998","pcpcounty":"","pcpid":101283,"pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["G89.18","S46.112A","S46.012A","M24.112","M19.012","M75.42","M25.512","M89.8X1","M75.22","Z98.890","I10.","E78.5","M81.0","E55.9","D84.9","J30.1","J45.20","N40.0","K21.9","H40.9","M19.90","Z12.5","D48.5","M75.122","R94.39","Z11.59","T84.84XA","S46.911A","S46.011A","M75.41","Z23.","F41.9","D12.2","Z86.010","Z80.0","Z01.810","Z01.812","Z01.818","R94.31","Z79.01","Z51.81","R07.89","E78.00","Q24.5","J42.","Z87.891","Z79.82","Z79.83","Z79.52","Z79.899","Z82.49","Z82.3","Z98.1","M06.4","M25.519","M81.8","M19.011","R05.","R06.02","J45.21","M06.9","H53.482","H40.1131","S43.432A","Z85.828","L57.4","L57.0","D89.9","C44.612","M75.111","Z11.4","M54.5","M79.643","Z12.11","K57.30","K63.5","I49.3","I44.7","Z78.9"],"date":["2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-11-03","2020-09-15","2020-09-15","2020-09-15","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-06-16","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2020-11-19","2020-03-19","2020-11-18","2020-07-27","2020-07-25","2020-09-15","2020-11-10","2020-11-10","2020-06-24","2020-11-19","2021-05-19","2020-07-02","2020-07-02","2020-07-02","2020-07-23","2020-07-13","2020-09-04","2020-09-04","2020-07-13","2020-07-13","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2021-01-26","2020-07-27","2020-07-27","2020-07-27","2021-01-26","2021-01-26","2021-01-26","2020-11-10","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2020-07-07","2020-07-07","2020-09-15","2020-03-19","2020-03-19","2020-03-19","2020-09-04","2020-03-25","2020-11-18","2021-05-19","2021-01-26","2021-01-26","2020-07-02","2020-07-02","2020-07-02","2020-07-23","2020-07-23","2020-09-04"],"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":[["","00093075210","ATENOLOL","50MG","10","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","50","Select","Select",""],["","00591505210","PREDNISONE","5MG","30","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","-30","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","50","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","60","Select","Select",""],["","64380076921","PEG-3350\/KCL","\/SODIUM","4000","Select","Select",""],["","43386009019","GAVILYTE-G","","4000","Select","Select",""],["","00378965132","TRAVOPROST","0.00%","-2","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","-90","Select","Select",""],["","00555032302","HYDROXYZ","25MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00363021807","ASPIRIN-81","81MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","62542030117","HYD","10-8\/5ML","100","Select","Select",""],["","00904404073","ASPIRIN","81MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","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":""}]}]}