{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M  ASILHCOBAL ","gend":1,"add":"J GNIK 31912 # TC NHO","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1970-11-09","age":"","mstatus":"","insh":"93000910*650","cliId":"","pno":"5975707606","cno":"","email":"","ename":"","eno":"","pphy":"SAMARAS, THOMAS A MD","ppno":7574812333,"pcpadd":"1120 FIRST COLONIAL RD STE 101,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"Privia - First Colonial Family Practice","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":" ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.641","M79.642","M25.532","M25.531","M25.521","M25.522","M62.81","M54.2","M54.5","G35.","D50.8","F33.1","F43.12","F10.11","K63.5","F41.1","R40.0","G25.81","R06.83","G47.33","F32.9","D73.89","R10.12","K44.9","Z98.84","G43.009","R94.02","Z12.11","R13.10","E66.9","J45.909","Z86.010","R19.4","K21.9","Z87.11","Z79.1","D50.9","F43.23","D64.9","Z20.828","Z20.822","R19.7","R30.9","R05.9","K91.2","E53.8","F41.8","R42.","Z86.79","K59.00","Z68.33","R63.4","Z11.59","Z12.31","Z87.898","J45.30","B34.9","R53.83","R21.","H69.93","Z02.9","T85.898A","R11.0","D51.8","Z00.00","N89.8","N76.0","F32.A","G56.21","N39.0","F10.21","B00.9","M54.9","Z87.39","Z98.82","T85.848A","R41.840","F41.9","M79.7","E66.01","Z68.32","F10.20","Z87.891","Z79.899","R10.9","R12.","M54.12","R20.2","R07.9","M54.50","B37.3","S39.011A","U07.1","Z88.1","Z88.2","Z88.6","Z88.8","R11.2","E55.9","B07.9","Z90.710","D17.1","B07.8","R10.33","G43.719","G43.909"],"date":["2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2022-03-16","2021-08-31","2022-07-08","2022-04-08","2021-09-10","2021-09-10","2021-09-10","2021-09-25","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2022-01-04","2022-05-17","2022-01-17","2022-05-18","2022-08-11","2021-09-16","2021-09-25","2021-09-25","2021-11-03","2022-03-16","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2022-05-18","2021-11-01","2022-08-11","2022-02-08","2023-01-08","2022-02-04","2022-02-04","2022-02-04","2022-05-18","2022-04-08","2022-04-08","2022-08-11","2021-03-16","2021-12-06","2021-07-16","2021-09-09","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2023-01-08","2022-07-08","2022-02-10","2022-02-10","2022-02-10","2022-03-16","2022-11-28","2021-09-09","2022-03-12","2021-12-06","2021-11-03","2022-03-16","2022-05-25","2022-02-08","2022-01-17","2022-01-17","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-05-17","2022-05-17","2022-06-14","2022-08-11","2022-08-11","2021-12-06","2021-12-06","2021-12-06","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2021-07-13","2021-09-09","2021-09-09","2021-09-14","2021-09-14","2022-01-04","2023-02-27","2022-12-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","31722070830","FAMCICLOVIR","TAB 500MG","4","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","15","Select","Select",""],["","65862001230","SERTRALINE","TAB 50MG","45","Select","Select",""],["","70436001104","BUPROPN HCL","TAB 300MG XL","90","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00378932132","WIXELA INHUB","AER 250\/50","60","Select","Select",""],["","51759020210","AJOVY","INJ 225\/1.5","2","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","6","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","59148003613","REXULTI","TAB 0.5MG","30","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00591555601","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","00023114501","BOTOX","100 UNIT","2","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","29300041301","CYCLOBENZAPR","TAB 5MG","28","Select","Select",""],["","16714069301","FLUCONAZOLE","TAB 200MG","1","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","52268020101","SUTAB","TAB","24","Select","Select",""],["","65862060012","RIZATRIPTAN","10 MG","12","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00093310953","AMOXICILLIN","500 MG","30","Select","Select",""],["","62332050606","AZELASTINE","DRO 0.0005","6","Select","Select",""],["","51672130200","TERCONAZOLE","CRE 0.008","20","Select","Select",""],["","65162011510","HYDROCO\/APAP","TAB 7.5-325","15","Select","Select",""],["","16714047701","AMOX\/K CLAV","TAB 500-125","14","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","59310030240","QVAR REDIHAL","AER 40MCG","11","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","65162027210","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00173071820","FLOVENT HFA","AER 44MCG","11","Select","Select",""],["","50742050524","SCOPOLAMINE","DIS 1MG\/3DAY","1","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","10","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","16","Select","Select",""],["","50228015801","CELECOXIB","CAP 200MG","10","Select","Select",""],["","70010010801","GABAPENTIN","CAP 100MG","21","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","18","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","57237007530","ONDANSETRON TAB","4MG","12","Select","Select",""],["","72647033104","METHYLPRED TAB","4MG","21","Select","Select",""],["","70710111108","TIZANIDINE CAP","2MG","60","Select","Select",""],["","70436001104","BUPROPN HCL TAB","300MG XL","90","Select","Select",""],["","00172392570","DIAZEPAM TAB","2MG","15","Select","Select",""],["","65862001230","SERTRALINE TAB","50MG","30","Select","Select",""],["","69097012303","TOPIRAMATE TAB","50MG","60","Select","Select",""],["","31722070830","FAMCICLOVIR TAB","500MG","4","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","00378932132","WIXELA INHUB AER","250\/50","60","Select","Select",""],["","59148003613","REXULTI TAB","0.5MG","30","Select","Select",""],["","00054418425","DEXAMETHASON TAB","4MG","6","Select","Select",""],["","51759020210","AJOVY INJ","225\/1.5","2","Select","Select",""],["","16571020110","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","90","Select","Select",""],["","00093031101","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","65162003310","APAP\/CODEINE TAB","300-30MG","12","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","00406117003","NALTREXONE TAB","50MG","30","Select","Select",""],["","31722095801","BENZONATATE CAP","200MG","30","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","60","Select","Select",""],["","29300041301","CYCLOBENZAPR TAB","5MG","28","Select","Select",""],["","00591555601","PROPRANOLOL TAB","40MG","60","Select","Select",""],["","62332050606","AZELASTINE DRO","0.05%","6","Select","Select",""],["","00023114501","BOTOX INJ","100UNIT","2","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00093310953","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","65757030001","VIVITROL INJ","380MG","1","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","16714043901","NITROFURANTN CAP","100MG","10","Select","Select",""],["","67877026218","RIZATRIPTAN TAB","10MG","12","Select","Select",""],["","16571066401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","16714047701","AMOX\/K CLAV TAB","500-125","14","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","65162011510","HYDROCO\/APAP TAB","7.5-325","15","Select","Select",""],["","51672130200","TERCONAZOLE CRE","0.8%","20","Select","Select",""],["","65162027210","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","59310030240","QVAR REDIHAL AER","40MCG","11","Select","Select",""],["","65862007701","CIPROFLOXACN TAB","500MG","14","Select","Select",""],["","45802006435","TRIAMCINOLON CRE","0.1%","30","Select","Select",""],["","65862044830","VALACYCLOVIR TAB","500MG","30","Select","Select",""],["","00173071820","FLOVENT HFA AER","44MCG","11","Select","Select",""],["","50228015801","CELECOXIB CAP","200MG","10","Select","Select",""],["","50742050524","SCOPOLAMINE DIS","1MG\/3DAY","1","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","10","Select","Select",""],["","65162004710","OXYCODONE TAB","5MG","16","Select","Select",""],["","70010010801","GABAPENTIN CAP","100MG","21","Select","Select",""],["","59746017506","PREDNISONE TAB","20MG","18","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","60","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","70436001104","BUPROPION XL","300 MG","90","Select","Select",""],["","00406117003","NALTREXONE HCL","50 MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","30","Select","Select",""]]}},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}