{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" W  SEMAJLLEIHSAD","gend":0,"add":"OL 87142NL SREV","city":"WINDSOR","state":"VA","zip":"23487-9998","dob":"1970-08-11","age":"","mstatus":"","insh":"0184110*69","cliId":"","pno":"4575757684","cno":"","email":"","ename":"","eno":"","pphy":"CYR, DAVID DO","ppno":7574847386,"pcpadd":"3235 ACADEMY AVE STE 101","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":"23703-9998","pcpcounty":"","pcpid":"","pcpname":"Privia - Churchland Family Medicine, P.C.","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":["R11.0","R12.","R10.13","R19.8","F17.200","D48.5","Z71.9","K21.9","F10.10","G47.33","B18.2","K31.89","Z12.11","Z00.00","I10.","G62.9","E78.5","D12.6","F11.11","Z86.19","R79.89","R06.83","Z68.33","E66.9","G47.00","G47.36","G47.37","D50.9","R74.01","R35.1","J30.9","F32.1","R60.9","K63.5","Z88.0","D22.5","F32.9","F17.210","R73.9","R22.40","Z12.5"],"date":["2022-11-09","2022-10-04","2022-11-30","2022-10-04","2022-10-04","2022-10-14","2022-10-14","2023-06-22","2022-11-30","2023-03-23","2022-11-21","2022-11-09","2021-08-30","2021-06-22","2023-06-22","2021-06-22","2023-06-22","2021-06-28","2023-06-22","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2023-06-22","2021-12-29","2021-12-29","2021-12-29","2021-01-27","2022-09-27","2021-01-26","2021-01-26","2022-08-31","2021-06-22","2021-06-28","2022-09-27","2022-10-14","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2023-06-22"],"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":[]},{"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":[["","65162041503","BUPREN\/NALOX","SUB 8-2MG","30","Select","Select",""],["","68180063709","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68645058854","LISINOP\/HCTZ","TAB 20-12.5","180","Select","Select",""],["","68180094111","TESTOSTERONE","GEL 0.0162","75","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","10","Select","Select",""],["","52817036100","METOPROL","TAB 50MG","90","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","13668013710","ESCITALOPRAM OXALATE","20 MG","90","Select","Select",""],["","00054018913","BUPRENORPHINE-NALOXONE","8 MG-2 MG","30","Select","Select",""],["","65162041503","BUPREN\/NALOX SUB","8-2MG","8","Select","Select",""],["","57664047758","METOPROLOL TARTRATE","50 MG","90","Select","Select",""],["","57664047758","METOPROL TAR TAB","50MG","90","Select","Select",""],["","70377002911","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","10","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","13668013601","ESCITALOPRAM TAB","10MG","90","Select","Select",""],["","67877032005","IBUPROFEN TAB","600MG","20","Select","Select",""],["","31722071290","PANTOPRAZOLE TAB","20MG","180","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","120","Select","Select",""],["","00406012301","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","00378668877","PANTOPRAZOLE SODIUM","20 MG","180","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":""}]}]}