{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   E BLACK JR","gend":0,"add":"826 W OCEANVIEW AVE APT B","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1958-05-30","age":"","mstatus":"","insh":"7062532*01","cliId":"","pno":"757\/560-7806","cno":"757\/560-7806","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\/366-9211","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":["N40.1","N13.8","R21.","E78.89","E07.9","B00.9","L57.0","Z48.89","Z71.9","L81.4","D22.9","L82.1","R76.0","F40.10","K21.9","I82.4Z2","Z00.00","Z12.5","I82.512","I82.532","I87.2","D68.9","Z85.828","I82.409","I26.99","L56.8","I78.1","Z12.83","C44.719","K22.70","R74.0","M54.16","Z12.11","Z80.42","H43.399","Z86.79","G44.89","Q07.00","G25.0","I82.412","I82.432","Z86.718","M79.89","N52.9","Z79.01","Z86.711","M77.11","R00.2","R94.39","R07.9","I49.1","G93.5","Z71.1","Z98.890","I08.8","Z82.49","Z87.891","R00.0","I49.3","I47.1","I48.0","Z91.030","Z91.013","Z79.82","Z79.899","I51.89","Z86.39","Z87.19","J40.","Z78.9","E78.5","R79.89","R73.01","Z20.828"],"date":["2020-06-15","2020-06-09","2020-07-29","2021-08-09","2020-07-29","2020-07-29","2021-05-19","2020-02-12","2020-10-14","2021-05-19","2021-05-19","2021-05-19","2021-08-09","2021-08-09","2021-08-09","2020-07-14","2021-07-27","2021-07-07","2021-07-09","2021-07-09","2020-07-14","2021-10-12","2020-10-14","2021-11-03","2021-11-03","2020-05-20","2020-05-20","2020-05-20","2020-01-21","2020-01-24","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2021-07-19","2021-07-28","2021-07-28","2021-07-28","2021-07-09","2021-07-09","2021-08-09","2021-07-09","2021-08-09","2021-08-09","2021-08-09","2021-07-07","2021-09-15","2021-07-30","2021-07-30","2021-07-21","2021-08-09","2021-08-09","2021-08-09","2021-07-27","2021-07-30","2021-07-30","2021-07-27","2021-08-04","2021-08-04","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-09-15","2021-09-15","2021-11-10","2021-11-10","2021-09-25"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",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":[["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","51672411806","FLUOROURACIL","5%","40","Select","Select",""],["","50458058030","XARELTO","10MG","10","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","-40","Select","Select",""],["","00603548221","PROPRANOLOL","10MG","90","Select","Select",""],["","31722064630","TADALAFIL","20MG","4","Select","Select",""],["","00378427677","VALACYCLOVIR","1GM","21","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","65862016001","ZOLPIDEM ","10MG","30","Select","Select",""],["","50458058030","XARELTO ","10MG","-10","Select","Select",""],["","31722064630","TADALAFIL ","20MG","4","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","21","Select","Select",""],["","51672411806","FLUOROURACIL ","5%","-40","Select","Select",""],["","00378018201","PROPRANOLOL ","10MG","90","Select","Select",""],["","00378427677","VALACYCLOVIR ","1GM","21","Select","Select",""],["","58160084252","BOOSTRIX ","","0","Select","Select",""],["","00115169449","EPINEPHRINE ","0.3MG","-2","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","-2","Select","Select",""],["","59267100002","PFIZER ","INJ 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":""}]}]}