{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B NEVETSDROFDAR","gend":0,"add":"I 0597LP NED","city":"QUINTON","state":"VA","zip":"23141-9998","dob":"1963-04-24","age":"","mstatus":"","insh":"1864210*93","cliId":"","pno":"7440829747","cno":8044774792,"email":"","ename":"","eno":"","pphy":"THOMAS, L DENNIS MD","ppno":8049324388,"pcpadd":"1850 POCAHONTAS TR","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":"23141-9998","pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","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":["Z51.11","K51.00","I49.9","I21.3","R07.89","R07.9","R06.89","I45.81","I51.9","E78.41","I25.10","I25.2","R94.31","I49.8","I35.8","I87.8","Z48.812","F32.89","Z95.5","Z79.899","Z79.02","Z79.82","K51.90","Z23.","K76.0","N28.1","R79.89","L57.0","D22.62","D22.5","D22.61","D22.72","L57.3","I10.","E78.49","I21.29","I50.21","I13.0","E66.9","F32.A","N18.30","Z68.33","R05.9","R20.2","I25.119","K30.","Z82.49","E86.0","N18.2","I95.1","I50.9","E78.5","R06.00","I42.8","Z79.84","L91.8","I77.810","Z87.2","D48.5","K51.20","H93.12","H92.02","H61.22","H90.42","T80.89XA","L82.1"],"date":["2022-07-15","2023-07-03","2022-08-20","2022-09-02","2022-08-20","2022-08-20","2022-08-20","2022-08-21","2023-06-07","2022-12-13","2023-07-21","2022-12-02","2022-08-22","2022-08-20","2022-08-22","2022-08-22","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2022-10-12","2023-04-14","2022-11-16","2022-11-16","2022-11-16","2023-03-06","2023-06-28","2023-06-28","2023-03-06","2023-03-06","2023-03-06","2022-08-20","2022-09-06","2022-08-20","2022-08-20","2022-08-22","2022-08-20","2022-08-20","2022-08-22","2022-08-20","2022-08-20","2022-08-20","2022-08-20","2022-08-20","2022-08-20","2022-08-22","2022-08-20","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-09-02","2022-10-10","2022-08-21","2022-10-10","2023-06-28","2023-04-14","2023-07-21","2023-05-12","2023-05-12","2023-06-12","2023-07-21","2023-06-28"],"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":[["","72511076002","REPATHA SURECLICK","140 MG\/ML","2","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","82009002030","ROSUVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","55566410001","EUFLEXXA INJ","10MG\/ML","6","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","59762330403","NITROGLYCERN SUB","0.4MG","100","Select","Select",""],["","68382009301","CARVEDILOL TAB","6.25MG","60","Select","Select",""],["","68382000301","AZATHIOPRINE TAB","50MG","360","Select","Select",""],["","16729018201","HYDROCHLOROT TAB","12.5MG","30","Select","Select",""],["","68462026430","ROSUVASTATIN TAB","40MG","30","Select","Select",""],["","00904404073","ASPIRIN CHW","81MG","30","Select","Select",""],["","72511076002","REPATHA SURE INJ","140MG\/ML","2","Select","Select",""],["","67877049090","EZETIMIBE TAB","10MG","90","Select","Select",""],["","00186077760","BRILINTA TAB","90MG","60","Select","Select",""],["","00904679489","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","00378395305","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","59267030401","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","68382000301","AZATHIOPRINE","50 MG","360","Select","Select",""],["","65862014305","CARVEDILOL","6.25 MG","180","Select","Select",""],["","00186077760","BRILINTA","90 MG","60","Select","Select",""],["","31722071001","SILDENAFIL CITRATE","50 MG","30","Select","Select",""],["","13668058130","TADALAFIL","20 MG","30","Select","Select",""],["","00904731427","ACETAMINOPHEN ER","650 MG","24","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":""}]}]}