{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YERFFEJSEHGUH S ","gend":0,"add":"SBOCAJ 243DR REDDAL ","city":"LEXINGTON","state":"VA","zip":"24450-9998","dob":"1962-12-07","age":"","mstatus":"","insh":"7372220*41","cliId":"","pno":"86\/7182873-8","cno":"","email":"","ename":"","eno":"","pphy":"DUBIT, SCOTT MD","ppno":"434\/544-2315","pcpadd":"650 N LEE HWY","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":24450,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"ACA","lob":"Small Group","region":"ROANOKE ALLEGHANY","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":["R06.09","J98.4","Z85.110","R79.82","I31.3","E78.2","E55.9","Z91.89","Z68.29","Z12.11","L72.11","D22.5","L57.8","Z90.2","R91.8","K76.0","I30.0","R07.9","R74.8","Z85.118","Z00.00","M79.645","E66.3","R21.","H60.549","C34.12","F33.9","G63.","K76.9","Q25.44","D48.5","L82.1","Z09.","Z87.2","Z11.59","L72.8","Z80.8","L82.0","L29.8","L53.8"],"date":["2022-03-01","2022-03-11","2022-03-11","2022-03-07","2022-03-25","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-08-30","2021-12-13","2021-12-13","2021-12-13","2022-03-11","2022-03-11","2022-03-11","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2021-12-14","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18"],"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":[["","68462053253","CLOBETASOL","SOL 0.0005","-50","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00832046530","NYAMYC","POW 100000","60","Select","Select",""],["","00378932032","WIXELA","AER 100\/50","60","Select","Select",""],["","00591256230","COLCHICINE","TAB 0.6MG","60","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","-60","Select","Select",""],["","57896098112","ASPIRIN","TAB 81MG EC","-84","Select","Select",""],["","00054032656","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","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":""}]}]}