{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D   ALIEHSNOSPMOHT ","gend":1,"add":" E 2111TS HT51","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1958-12-30","age":"","mstatus":"","insh":"2180210*10","cliId":"","pno":"42\/4087779-7","cno":"804\/359-1351","email":"","ename":"","eno":"","pphy":"PAHLE, NANCY JO MD","ppno":"804\/359-1351","pcpadd":"2201 GROVE AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","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":["E53.8","Z00.00","E78.5","E11.59","E11.21","E66.01","R56.9","I15.2","J96.20","J44.1","S62.617D","M25.642","S62.617A","Z12.11","N39.0","W19.XXXA","Y92.89","Y93.89","R82.81","Z12.31","I63.00","I10.","Z23.","E78.00","M79.645","E11.9","Z86.73","Z79.4","Z79.84","Z88.2","Z88.8","Z82.3","Z82.49","Z83.3","R41.82","I63.9","E11.49","I69.351","G93.40","I63.512","I69.320","N64.4","E55.9","I63.412","G81.91","I63.49","R47.01","R47.1","R00.0","E66.9","I25.10","D64.9","E11.65","R40.2362","R40.2142","R40.2252","I66.02","R73.9","G93.5","G93.41","R53.81","Z78.0","I51.7","I45.81","R53.1","Z74.09","Z11.59","R74.8","R06.83","R53.83","Z87.898","H25.13","Z01.419","F33.9","E78.2","R79.89","R91.8","N30.01"],"date":["2022-02-03","2021-01-27","2021-11-10","2021-12-07","2021-12-07","2021-12-07","2021-06-14","2021-12-07","2021-11-30","2021-11-30","2022-02-01","2022-02-01","2022-01-11","2021-08-30","2021-10-15","2021-10-24","2021-10-24","2021-10-24","2021-01-27","2021-01-27","2021-12-07","2021-10-24","2021-11-10","2021-11-10","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2019-04-22","2019-04-28","2019-04-29","2019-04-29","2019-04-28","2019-04-29","2019-04-29","2019-08-23","2020-12-03","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2020-06-03","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-18","2019-04-27","2019-04-27","2019-08-23","2019-04-18","2019-04-18","2019-04-24","2019-04-24","2019-08-05","2019-11-06","2020-06-03","2020-06-03","2020-06-03","2019-07-05","2019-08-05","2020-10-29","2019-04-18","2019-11-06","2019-04-18","2019-05-28"],"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":[["","68645047954","METOPROL","TAB 100MG ER","90","Select","Select",""],["","16729000301","GLIMEPIRIDE","TAB 4MG","90","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","200","Select","Select",""],["","59779013701","CVS","TAB 325MG EC","30","Select","Select",""],["","55111019630","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","70010049105","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","68180063809","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","68382013710","LOSARTAN","TAB 100MG","90","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","150","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","16","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","08214053080","PEN  NEEDLES","MIS 31GX5\/16","100","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","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":""}]}]}