{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EK   LEAHCIMNOSNHOJ NIV","gend":0,"add":"XOB OP4464 ","city":"CHARLOTTESVILLE","state":"VA","zip":"22905-9998","dob":"1960-03-21","age":"","mstatus":"","insh":"0810210*71","cliId":"","pno":"59\/4343546-3","cno":"","email":"","ename":"","eno":"","pphy":"FLOWERS, WILLIAM GILMER MD","ppno":"434\/973-1831","pcpadd":"3025 BERKMAR DR STE 1","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22901,"pcpcounty":"","pcpid":"","pcpname":"Privia - Charlottesville Family Medicine, PC","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","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":["M79.602","D57.3","Z91.030","Z91.018","Z83.3","Z80.9","Z83.49","M25.512","R91.8","I48.91","J18.9","U07.1","R97.20","N40.1","R06.89","R09.02","R00.0","R11.0","R11.11","M25.511","M75.41","M77.8","Z12.11","I48.0","J12.82","R19.7","D69.59","R73.9","Z87.891","Z88.1","Z79.899","R79.89","K40.90","N40.0","Z00.00","E55.9","I44.7","R94.31","Z48.89","R10.9","M72.2","R71.8"],"date":["2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-11-09","2021-12-11","2021-11-08","2021-11-11","2021-09-07","2021-09-07","2021-11-07","2021-11-08","2021-11-07","2021-11-07","2021-11-07","2022-03-03","2022-03-03","2022-03-03","2021-05-23","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-11","2020-07-01","2020-11-06","2021-12-07","2019-10-31","2020-07-01","2020-07-01","2020-01-27","2020-01-27","2020-12-01","2019-10-31"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","68180063509","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","00536333401","VITAMIN","TAB 1000UNIT","90","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","19515081652","FLULAVAL","INJ 2020-21","0","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","69097042107","CELECOXIB","CAP 200MG","20","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}