{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   A SULLIVAN","gend":0,"add":"353 10TH ST NW APT C","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1960-07-01","age":"","mstatus":"","insh":"20035800*01","cliId":"","pno":"434\/908-8097","cno":"434\/908-8097","email":"","ename":"","eno":"","pphy":"HANN, LOUISA J MD","ppno":"434\/244-4550","pcpadd":"310 OLD IVY WAY SUITE 201","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":145521,"pcpname":"SMJMG - Sentara Blue Ridge Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.51","N30.00","N40.1","R33.8","Z46.6","L98.8","E11.65","E11.40","J44.9","I69.351","E43.","M62.81","R26.89","E78.5","H40.9","F17.210","Z79.82","E11.69","D50.9","Z79.4","C34.2","Z92.3","E11.42","E11.9","F17.200","I69.30","N39.0","A41.9","Z20.822","R53.1","R62.7","R64.","Z68.1","Z16.11","H91.90","N39.490","Z79.84","R32.","Z87.09","E55.9","H20.9","C34.11","F32.9","R29.6"],"date":["2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-26","2021-04-26","2021-04-26","2021-07-16","2020-10-09","2021-04-04","2020-10-21","2020-10-21","2020-10-21","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2021-04-06","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2021-04-19","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09"],"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":[]},{"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}