{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANKLIN   D SULLIVAN","gend":0,"add":"2324 WILDWOOD RD","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1961-04-15","age":"","mstatus":"","insh":"1710656*01","cliId":"","pno":"757\/681-6046","cno":"757\/681-6046","email":"","ename":"","eno":"","pphy":"VACCARELLA, JOSEPH E MD","ppno":"757\/842-6180","pcpadd":"STE 101 1419 CEDAR ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":146583,"pcpname":"Cedar Road Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/842-6181","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H34.8320","Z00.00","I10.","E78.5","Z12.5","H35.033","H17.11","H25.13","E03.9","J96.01","J12.89","J45.909","E87.6","R94.5","U07.1","J12.82","R74.01","R91.8","Z87.891","I26.99","J18.9","Z87.09","R06.02","R09.02","R05.","M79.672","N17.9","D72.829","E66.9","J80.","I73.9","L97.529","J15.211","R06.03","R50.9","D72.823","J96.90","M62.262","R33.9","I48.91","Z46.59","I74.3","I96.","R06.01","Z93.0","I74.5","I70.202","E87.5","J90.","Z20.822","Z46.82","R47.01","R57.9","J96.20","R13.10","Z99.11","Z03.89","S81.802A","R06.00","R60.0","K92.1","I70.262","I99.8","K62.5","I48.0","I82.601","I82.409","N40.0","Z87.01","Z86.16","J44.0","A49.8","Z16.24","A49.02","I82.721","Z12.11","J98.4","G72.81","S88.119A","Z43.0","Z09.","J81.0","I82.629","K94.23","J44.9","J96.11","L90.5","J96.91","J96.00","S88.012S","G62.81","G62.9","I82.621","Z93.1","R03.0","E78.00","Z89.512","A41.9","R65.21","E87.1","D68.32","E87.0","R04.2","I82.402","I82.611","I82.B11","R20.0","R05.8","Z99.81","Z47.81","Z43.1","L89.322","E72.02"],"date":["2021-06-17","2020-09-04","2021-11-17","2020-09-04","2020-09-04","2021-06-17","2021-01-11","2021-06-17","2020-08-27","2021-11-17","2021-08-30","2021-10-14","2021-08-29","2021-10-13","2021-10-26","2021-10-14","2021-10-08","2021-10-15","2021-10-05","2021-08-13","2021-10-29","2021-08-13","2021-10-14","2021-08-13","2021-08-13","2021-08-30","2021-10-29","2021-08-23","2021-08-30","2021-10-20","2021-10-13","2021-09-21","2021-10-07","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-09-18","2021-10-10","2021-11-17","2021-08-22","2021-08-29","2021-10-05","2021-09-10","2021-10-14","2021-08-20","2021-09-09","2021-08-27","2021-08-29","2021-08-29","2021-08-29","2021-09-04","2021-09-05","2021-09-07","2021-10-26","2021-08-24","2021-09-03","2021-09-09","2021-09-10","2021-09-13","2021-09-30","2021-10-08","2021-10-05","2021-10-10","2021-10-21","2021-10-08","2021-10-21","2021-10-21","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-08-30","2021-10-14","2021-10-26","2021-10-26","2021-10-26","2021-10-15","2021-10-15","2021-10-20","2021-10-23","2021-11-01","2021-10-26","2021-09-09","2021-10-07","2021-10-29","2021-10-29","2021-09-30","2021-10-10","2021-10-14","2021-10-13","2021-10-05","2021-11-01","2021-11-01","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-18","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-18"],"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,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,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,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":[["","68001033508","LISINOPRIL","20MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","31","Select","Select",""],["","68382013210","TAMSULOSIN","0.4MG","180","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","20","Select","Select",""],["","68001033508","LISINOPRIL ","20MG","90","Select","Select",""],["","68382013210","TAMSULOSIN ","0.4MG","180","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","31","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","55111012705","CIPROFLOXACN ","500MG","20","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","-10","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","00054032756","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","57664050658","METOPROL","25MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","-10","Select","Select",""],["","00085461001","DULERA ","AER 200-5MCG","13","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","30","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","-60","Select","Select",""],["","00054032756","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","80777027399","MODERNA ","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":""}]}]}