{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIRSTEN   L NEXSEN","gend":1,"add":"4505 COLLEY AVE","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1972-02-20","age":"","mstatus":"","insh":"1895423*01","cliId":"","pno":"757\/535-1615","cno":"757\/535-1615","email":"","ename":"","eno":"","pphy":"SUN, TOMMY MD","ppno":"757\/507-0305","pcpadd":"STE 300 1950 GLENN MITCHELL","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":140395,"pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-0306","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","H53.9","Z23.","R39.89","F31.76","F31.81","R51.","H54.7","F90.9","R68.82","F33.42","F51.01","M54.5","M54.2","R82.90","R94.4","E03.9","Z87.448","Z00.00","Z11.3","Z01.419","R09.89","F90.2","Z63.0","Z59.9","R06.02","Z20.828","R31.9","Z71.9","F43.10","F33.1","N39.0","Z20.822","F43.12"],"date":["2021-08-25","2021-01-21","2021-01-21","2021-04-01","2021-11-24","2021-08-24","2020-03-26","2020-03-26","2021-11-16","2020-12-03","2020-12-03","2021-11-16","2020-01-09","2020-01-09","2021-03-19","2021-06-02","2021-03-19","2021-03-19","2020-11-05","2020-11-05","2020-11-10","2020-03-26","2021-11-16","2021-10-13","2020-04-30","2021-07-05","2020-12-18","2021-06-02","2021-06-02","2021-11-16","2021-11-16","2021-07-05","2021-08-25","2021-11-24"],"priorHcc":["","","","",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":[["","31722070530","VALACYCLOVIR","1GM","90","Select","Select",""],["","59417010710","VYVANSE","70MG","30","Select","Select",""],["","70954001910","PRAZOSIN","1MG","45","Select","Select",""],["","60505283503","ATOMOXETINE","80MG","30","Select","Select",""],["","10370010150","BUPROPN","150MG XL","-90","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","50111043401","TRAZODONE","100MG","180","Select","Select",""],["","00096070760","DRYSOL","20%","-60","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59417010710","VYVANSE ","70MG","-30","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","90","Select","Select",""],["","70954001910","PRAZOSIN ","1MG","45","Select","Select",""],["","60505283503","ATOMOXETINE ","80MG","-30","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","-90","Select","Select",""],["","50111043401","TRAZODONE ","100MG","90","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","00096070760","DRYSOL ","20%","-60","Select","Select",""],["","00005197102","PREVNAR ","","0","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","68180071160","CEFDINIR ","300MG","14","Select","Select",""],["","00115165903","PROPRANOLOL ","10MG","90","Select","Select",""],["","00115165903","PROPRANOLOL","10MG","90","Select","Select",""],["","68180071160","CEFDINIR","300MG","14","Select","Select",""],["","57664051083","MIRTAZAPINE","7.5MG","30","Select","Select",""],["","65862049101","QUETIAPINE","100MG","30","Select","Select",""],["","70010049110","METFORMIN","500MG ER","30","Select","Select",""],["","57664051083","MIRTAZAPINE ","TAB 7.5MG","-30","Select","Select",""],["","47335090488","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","59651017501","DOXEPIN ","CAP 50MG","-30","Select","Select",""],["","70010049110","METFORMIN ","TAB 500MG ER","30","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","",""],["No","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":""}]}]}