{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M  EINNOBYENTRUOC ","gend":1,"add":"AP 8021EVA SKR","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1957-08-19","age":"","mstatus":"","insh":"1704810*77","cliId":"","pno":"8475713091","cno":7574499805,"email":"","ename":"","eno":"","pphy":"CHARLTON, WILLIAM MD","ppno":7574812333,"pcpadd":"1120 FIRST COLONIAL RD STE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","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":["Z47.1","Z96.611","M25.611","M62.81","N39.0","G93.41","J01.00","I63.9","F41.9","R41.82","F43.22","K60.2","Z01.810","J96.00","R56.9","F05.","F17.200","R41.0","Z12.31","M25.511","J44.9","R06.00","Z72.0","C34.11","J30.2","K62.89","R30.0","J43.9","Z87.891","Z88.5","R42.","R07.9","Z90.2","G93.40","Z87.440","R06.03","Z46.82","R55.","R90.82","J96.01","R79.89","R39.9","R10.9","Z13.820","M85.80","R63.6","Z78.0","K52.9","Z85.118","Z85.820","Z98.1","Z90.49","R68.83","K86.1","R10.13","R63.4","R19.7","R93.89","K60.1","R15.9","K64.5","K21.9","G47.30","Z79.899","Z98.890","N30.01","R10.84","I05.1","I51.7","N30.00","R47.01","F12.90","F17.219","F32.A","L30.9","L82.1","Z85.828","L57.0","Z12.2","F17.210","J47.9","R44.3","R11.2","I21.4","R40.4","T42.6X1A","G92.8","T42.4X1A","G62.9","G89.29","G47.00","F41.0","F90.9","Z71.3","Z68.1","Z00.00","J43.2","E87.4","I95.9","E87.1","I24.8","Z20.822","R63.0","R33.9","G89.4","M65.342","M79.645","Z20.828","K43.2","M25.551","M54.50"],"date":["2021-08-06","2022-10-27","2021-06-08","2021-06-08","2023-02-05","2023-02-03","2021-12-08","2021-12-08","2023-02-07","2023-06-22","2022-06-27","2022-09-26","2022-09-13","2023-02-07","2023-02-07","2023-02-16","2023-02-16","2023-02-16","2023-03-21","2021-06-08","2023-02-11","2022-03-28","2023-02-05","2022-03-28","2022-03-28","2022-10-27","2023-02-03","2023-02-01","2023-02-01","2023-02-01","2022-08-07","2023-02-03","2023-02-06","2023-02-11","2023-02-06","2023-02-06","2023-02-06","2023-02-06","2023-02-06","2023-02-11","2023-02-11","2021-12-06","2021-12-06","2022-03-15","2022-03-15","2022-03-15","2022-03-15","2022-10-27","2023-02-01","2023-02-01","2022-10-27","2022-08-03","2022-08-03","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2023-02-09","2022-10-27","2022-10-27","2023-02-01","2023-02-01","2023-02-06","2023-02-06","2023-02-07","2023-02-07","2023-02-07","2023-02-07","2023-02-07","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-06-30","2023-02-03","2021-06-09","2021-12-06","2023-02-01","2023-02-05","2023-02-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2023-02-03","2021-12-06","2021-12-06","2022-02-03","2023-02-03","2022-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2021-06-03","2021-06-03","2021-12-28","2022-02-18","2023-04-03","2023-04-03"],"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":[["","00173086910","ANORO","AER 62.5-25","180","Select","Select",""],["","00406996201","TEMAZEPAM","CAP 30MG","30","Select","Select",""],["","52536068210","CARISOPRODOL","TAB 250MG","60","Select","Select",""],["","50228018001","GABAPENTIN","300 MG","60","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","4","Select","Select",""],["","00168034646","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","16714047701","AMOX\/K","TAB 500-125","6","Select","Select",""],["","00228202910","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","10","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","12","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","45802005935","NYSTATIN","CRE 100000","15","Select","Select",""],["","00172572880","FAMOTIDINE","20 MG","60","Select","Select",""],["","11822033670","RA","TAB 100MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","31604002718","B-12","TAB 2500MCG","30","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","51991029301","OXCARBAZEPINE","300 MG","180","Select","Select",""],["","10006073021","VITAMIN B-","1 100 MG","90","Select","Select",""],["","68462067860","LACOSAMIDE","50 MG","120","Select","Select",""],["","16714003501","LEVETIRACETAM","500 MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","30","Select","Select",""],["","00131247735","VIMPAT","50 MG","120","Select","Select",""],["","50428034400","MELATONIN","5 MG","90","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","14","Select","Select",""],["","88888888887","DMR ADJUSTMENT","","1","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","60","Select","Select",""],["","00228202910","ALPRAZOLAM TAB","0.5MG","30","Select","Select",""],["","00173086910","ANORO ELLIPT AER","62.5-25","180","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","36","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","36","Select","Select",""],["","65862018830","ONDANSETRON TAB","8MG","90","Select","Select",""],["","00527058601","DICYCLOMINE CAP","10MG","60","Select","Select",""],["","29300041301","CYCLOBENZAPR TAB","5MG","14","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","17478071130","LIDOCAINE GEL","2% JELLY","30","Select","Select",""],["","00172392560","DIAZEPAM TAB","2MG","10","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","20","Select","Select",""],["","69315031228","PROCTO-MED CRE HC","2.5%","28","Select","Select",""],["","38779022704","DILTIAZEM POW","","30","Select","Select",""],["","70461012203","FLUAD QUADRI INJ","2022-23","0","Select","Select",""],["","33342040530","LIDOCAINE OIN","5%","30","Select","Select",""],["","11822330670","RA MINERAL OIL","","473","Select","Select",""],["","52817081701","HC PRAMOXINE CRE","2.5-1%","30","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","20","Select","Select",""],["","00093342501","LORAZEPAM TAB","0.5MG","30","Select","Select",""],["","57237002901","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","60219204301","DEXAMETHASON TAB","4MG","6","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","16714071302","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","42806071501","BENZONATATE CAP","200MG","30","Select","Select",""],["","60432026415","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","65162068110","PHENAZOPYRID TAB","100MG","6","Select","Select",""],["","29300014901","QUETIAPINE FUMARATE","100 MG","30","Select","Select",""],["","16714085202","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","90","Select","Select",""],["","16714020030","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","Select","Select",""],["","51645087510","THERA-M","27MG-0.4MG","30","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":""}]}]}