{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W   DIVADYELSAEB ","gend":0,"add":"AET 2912RD ELADS","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1961-01-06","age":"","mstatus":"","insh":"2202110*10","cliId":"","pno":"34\/7579351-0","cno":"757\/714-8264","email":"","ename":"","eno":"","pphy":"KILLEN, JOSEPH MD","ppno":"757\/481-2333","pcpadd":"1120 FIRST COLONIAL RD STE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":"","pcpname":"Privia - First Colonial Family Practice","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","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":["M45.0","I10.","E66.3","Z20.828","R05.9","Z23.","M06.9","Z12.11","L57.0","L82.1","L81.4","D18.00","L57.8","D22.9","L90.5","Z85.828","Z12.83","Z71.9","Z79.899","N48.6","Z12.5","R74.8","E66.9","R79.89","M14.88","C44.320","D48.5","R10.30","R19.5","K21.9","H69.92","L72.0","Z00.00","D04.30","L81.2"],"date":["2021-03-31","2021-06-02","2021-03-31","2021-11-24","2021-11-24","2021-04-01","2021-04-03","2021-08-30","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2019-05-03","2019-11-26","2019-09-14","2019-09-19","2020-10-02","2019-09-19","2019-09-19","2020-11-30","2020-11-30","2020-12-07","2020-12-07","2020-12-07","2020-11-01","2020-08-01","2019-05-03","2020-12-30","2020-01-16"],"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":[["","68180065208","DOXYCYC","CAP 100MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","58406003204","ENBREL","INJ 50MG\/ML","4","Select","Select",""],["","00378479106","FLUOROURACIL","CRE 0.05","40","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","16","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":""}]}]}