{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FUH   ROLYATLLIHGOC NAMF","gend":1,"add":"RBLOH 564DAOR KOO","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1991-01-03","age":"","mstatus":"","insh":"9530210*03","cliId":"","pno":"67\/7579786-9","cno":"","email":"","ename":"","eno":"","pphy":"TENNANT, BRADLEY 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":"Individual","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":["R87.610","N87.1","Z98.890","F33.2","Z12.4","N84.1","Z00.00","R87.612","B97.7","N93.9","M79.7","M41.9","R87.619","G43.009","N87.0","N39.0","R87.613","Z32.02","K80.20","N20.0","Z79.3","F41.9","K21.9","H61.22","F33.9","G43.711","N76.0","K58.1","R03.0","R51.","Z30.9","F32.2"],"date":["2021-03-31","2021-12-07","2022-03-04","2021-12-08","2022-01-27","2022-03-08","2021-10-05","2021-03-29","2021-12-04","2021-08-25","2022-01-04","2022-01-04","2021-01-29","2021-05-04","2021-12-04","2022-02-14","2022-03-04","2022-03-04","2022-02-14","2022-02-14","2021-01-27","2021-01-27","2021-01-27","2021-07-03","2020-12-28","2020-09-28","2020-10-27","2020-07-04","2020-01-14","2020-01-14","2020-01-14","2020-07-04"],"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":[["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","00456150055","SAVELLA","MIS TITR PAK","55","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","69367020301","BUT\/APAP\/CAF","TAB ","-30","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","7","Select","Select",""],["","62332012290","PREGABALIN","CAP 100MG","60","Select","Select",""],["","00093342510","LORAZEPAM","TAB 0.5MG","90","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","68462064693","ASHLYNA","TAB ","-91","Select","Select",""],["","65862017160","TOPIRAMATE","TAB 25MG","-90","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","62332038690","MODAFINIL","TAB 200MG","-30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","70954008510","CHLORZOXAZON","TAB 500MG","90","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","28","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":""}]}]}