{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRAIG   W SULLIVAN","gend":0,"add":"640 INDEPENDENCE PKWY STE 200","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1958-03-20","age":"","mstatus":"","insh":"2057637*02","cliId":"","pno":"757\/436-4800","cno":"757\/436-4800","email":"","ename":"","eno":"","pphy":"PEARMAN, STEVEN D MD","ppno":"757\/252-9800","pcpadd":"1380 TUSCANY DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":117382,"pcpname":"SMG - Sentara Family Medicine Physicians - Nimmo","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/481-1959","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9793","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.552","M50.30","R07.9","I42.8","R00.8","M79.652","Z08.","Z85.828","L57.8","L91.8","L57.0","R03.0","I50.9","G47.30","Z86.718","Z99.89","Z88.8","M54.5","M54.16","I10.","Z12.11"],"date":["2021-03-25","2021-03-17","2020-06-23","2020-06-23","2021-02-25","2021-02-25","2020-03-12","2021-02-25","2020-03-12","2020-03-12","2020-03-12","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-03-25","2021-03-10","2021-08-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",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":[["","00781151601","POT CHLORIDE","8MEQ SR","90","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","16","Select","Select",""],["","51862036240","FLUOROURACIL","5%","-40","Select","Select",""],["","68382009301","CARVEDILOL","6.25MG","180","Select","Select",""],["","70010077001","METHOCARBAM","750MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","21","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","30","Select","Select",""],["","00378427693","VALACYCLOVIR","1GM","8","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","43547035310","LISINOPRIL","10MG","90","Select","Select",""],["","00093735556","FINASTERIDE","5MG","90","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","90","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","51862036240","FLUOROURACIL ","5%","40","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","16","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","40","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","30","Select","Select",""],["","43547035310","LISINOPRIL ","10MG","90","Select","Select",""],["","68382009301","CARVEDILOL ","6.25MG","180","Select","Select",""],["","00093735556","FINASTERIDE ","5MG","90","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","00781151601","POT  CHLORIDE","8MEQ SR","90","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","21","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","00378427693","VALACYCLOVIR ","1GM","-8","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","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":""}]}]}