{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REHPOTSIRHCELKREM R   ","gend":0,"add":"LGAEB 206NL NUR E","city":"ALBERTA","state":"VA","zip":"23821-9998","dob":"2004-07-20","age":"","mstatus":"","insh":"0394910*62","cliId":"","pno":"32\/4344061-3","cno":"","email":"","ename":"","eno":"","pphy":"POWERS III, GRAHAM H MD","ppno":"434\/584-2025","pcpadd":"514 W ATLANTIC ST","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F91.3","F31.9","F90.2","J30.9","R05.","V54.12","R04.0","L60.0","S52.501A","W19.XXXA","Z20.822","Z20.828","F32.9","V58.89","Z62.820","N39.0","L02.611","L02.612","Z11.59","Z09.","Z87.2","W17.89XA","H52.11","H52.02","H52.223","F32.1","S41.112A","H04.123","H50.52","H47.232","J06.9","Z68.52","L25.5","Z00.129","R01.1","R10.9","A38.9","K59.00","T07.XXXA","V09.09XA","R01.0"],"date":["2021-04-04","2021-09-03","2021-09-03","2021-03-22","2021-03-22","2021-05-27","2020-06-03","2021-09-29","2021-04-28","2021-04-27","2021-08-26","2021-12-30","2020-03-09","2020-03-09","2020-03-09","2021-06-28","2021-09-29","2021-09-29","2020-12-15","2021-03-17","2021-03-17","2021-04-28","2021-02-23","2021-02-23","2021-02-23","2019-07-07","2019-05-02","2019-10-29","2019-10-29","2019-10-29","2019-02-06","2019-10-15","2019-03-08","2019-10-14","2019-10-14","2019-02-12","2019-02-12","2019-02-12","2019-04-20","2019-04-20","2019-10-23"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","29300013901","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","00078043205","FOCALIN","CAP 20MG","30","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","30","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","58657067601","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","65162071110","GUANFACINE","TAB 1MG","60","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","00115992101","DEXMETHYLPHE","CAP 20MG ER","30","Select","Select",""],["","49348014392","SM","POW ","510","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","49035030603","EQ","POW ","510","Select","Select",""],["","49035010104","ALLERGY","LIQ 12.5\/5ML","240","Select","Select",""],["","00143973805","PREDNISONE","TAB 20MG","5","Select","Select",""],["","16714089802","LORATADINE","TAB 10MG","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":""}]}]}