{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A  AIHTNYCNOSRETTAP ","gend":1,"add":"NELB 1583DAOR MIEH","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1965-07-20","age":"","mstatus":"","insh":"8020210*00","cliId":"","pno":"9243448245","cno":"","email":"","ename":"","eno":"","pphy":"DONOVAN, DEIRDRE E MD","ppno":4348171818,"pcpadd":"STE 9 310 AVON STREET","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22902-9998","pcpcounty":"","pcpid":"","pcpname":"Privia - Downtown Family Health Care, Inc","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","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":["N83.201","N83.8","Z90.710","R93.89","R19.00","M25.851","Z00.00","C49.A3","K76.0","D27.0","D47.3","E03.9","K52.831","Z13.31","F41.9","I35.0","Z12.31","M23.92","R93.7","N83.202","K63.89","R10.31","M25.852","M25.552","D75.839","R53.83","R77.8","Z00.01","D75.838","M25.512","Z12.11","D73.4","R79.82","M94.262","S83.242A","M25.551","J40.","R63.5","M25.562","M71.22","R60.0","G89.18","S49.92XA","R79.89","F41.8","R10.2","I35.9","K56.50","N83.209","N83.291","R55.","K91.72","E66.9","D49.0","K52.9","F17.210","Z68.30","K66.0","N73.6","N32.89","R33.9","Z79.899","Z88.5","Z79.82","Z79.890","R19.7","C49.A0","Z85.00","Z80.3"],"date":["2021-05-25","2022-06-10","2021-05-25","2021-05-25","2022-06-02","2021-12-17","2022-05-04","2023-03-27","2022-06-10","2022-06-10","2022-08-02","2023-07-18","2022-11-03","2021-04-05","2021-04-05","2021-04-05","2023-04-13","2021-05-01","2021-05-01","2022-06-10","2022-06-10","2022-06-10","2022-12-12","2023-03-03","2023-03-27","2021-03-04","2021-03-04","2022-05-04","2022-05-04","2022-05-04","2022-05-28","2023-03-27","2021-04-19","2021-05-07","2021-05-07","2021-12-17","2022-05-31","2023-03-13","2021-04-21","2021-05-01","2021-05-01","2022-06-10","2023-03-03","2021-03-04","2023-05-10","2022-06-10","2023-05-16","2022-06-10","2022-06-10","2022-06-10","2022-03-09","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-11-03","2023-03-02","2023-04-13","2023-04-13"],"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":[["","65862019399","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00378180910","LEVOTHYROXIN","TAB 100MCG","90","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","60","Select","Select",""],["","43386005019","GAVILYTE-N","SOL FLAV PK","4000","Select","Select",""],["","16714082901","BUDESONIDE","CAP 3MG DR","67","Select","Select",""],["","00054001825","PREDNISONE","TAB 20MG","18","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","12","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","29300012510","MELOXICAM","15 MG","90","Select","Select",""],["","16714082901","BUDESONIDE DR","3 MG","90","Select","Select",""],["","16714072103","FLUOXETINE CAP","20MG","90","Select","Select",""],["","00378180910","LEVOTHYROXIN TAB","100MCG","90","Select","Select",""],["","29300012510","MELOXICAM TAB","15MG","90","Select","Select",""],["","42858000101","OXYCODONE TAB","5MG","20","Select","Select",""],["","70156010501","HYOSCYAMINE SUB","0.125MG","30","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","32909074103","READI-CAT","2 2 % (W\/V)","450","Select","Select",""],["","16714082901","BUDESONIDE CAP","3MG DR","90","Select","Select",""],["","68180096803","LEVOTHYROXINE SODIUM","88 MCG","90","Select","Select",""],["","00069108530","PAXLOVID TAB","300-100","30","Select","Select",""],["","16729044316","BUPROPION XL","150 MG","30","Select","Select",""],["","00228202910","ALPRAZOLAM","0.5 MG","30","Select","Select",""],["","59762120601","LIOTHYRONINE SODIUM","5 MCG","90","Select","Select",""],["","16714017201","TIZANIDINE HCL","4 MG","40","Select","Select",""],["","47781019601","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","16","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":""}]}]}