{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YMMATSRENNA C","gend":1,"add":"MLAC 9071NL DOOW ","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1979-05-13","age":"","mstatus":"","insh":"2552110*03","cliId":"","pno":"8575714969","cno":7574981220,"email":"","ename":"","eno":"","pphy":"SAMARAS, THOMAS A 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":["R30.9","J01.90","E11.9","L65.9","E78.5","K76.0","E11.65","Z11.4","Z11.59","Z12.31","Z13.0","Z13.220","Z13.1","R94.5","R16.0","K80.20","R74.01","D72.829","Z79.84","E78.2","H10.30","N39.0","Z01.419","Z30.41","E66.9","D75.89","J20.9","Z71.3","R39.9"],"date":["2021-08-20","2022-11-11","2022-07-27","2022-10-25","2022-10-25","2022-07-27","2022-10-25","2022-10-25","2022-10-25","2022-08-03","2021-07-01","2021-10-01","2021-07-01","2021-07-19","2021-07-19","2021-07-19","2022-04-28","2022-01-27","2021-11-01","2021-07-22","2022-06-30","2022-12-26","2023-02-07","2023-02-07","2023-02-07","2021-07-09","2022-11-11","2021-08-26","2023-01-05"],"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":[["","68462056529","NORGEST\/ETHI","TAB ESTRADIO","84","Select","Select",""],["","59746021106","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","55111068405","IBU","TAB 800MG","30","Select","Select",""],["","16714036304","TRI-LINYAH","TAB ","84","Select","Select",""],["","53746027201","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","51672126705","TRIAMCINOLON","PST DEN 0.1%","10","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","29300024601","BUSPIRONE","TAB 15MG","180","Select","Select",""],["","16729017001","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70700012185","TRI-ESTARYLL","TAB ","84","Select","Select",""],["","16714036004","MONO-LINYAH","TAB 0.25-35","84","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","27808015601","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","43547035210","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","30","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","70436001104","BUPROPN","TAB 300MG XL","90","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","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":""}]}]}