{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELLERREHCTNAYRB L  ","gend":1,"add":"SDNEIRF 9021H TPA QS PIH","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1989-06-08","age":"","mstatus":"","insh":"1039110*44","cliId":"","pno":"47\/7578217-9","cno":"","email":"","ename":"","eno":"","pphy":"ELSTEIN, MORRIS MD","ppno":"757\/481-4036","pcpadd":"1744 SIR WILLIAM OSLER DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","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":["F90.2","F31.81","F51.01","F41.1","B00.0","F90.0","J01.10","J98.8","B97.89","R19.7","F90.9","U07.1","N30.00","F31.9","B34.9","F60.3","V62.84","R30.0","NO DATA","A59.9","E66.9","Z87.440","Z91.040","Z68.36","Z20.2","J10.1","K08.89","R68.89","F32.9","Z51.81","Z71.1","J06.9","R52.","R10.9","B37.3","N76.0","M25.561","K27.3","R35.89","G44.209","F41.9","G50.0","R51.","R05.","J30.2","H69.93","J34.89","K04.01","J02.0","S46.811A","F31.11","K08.409","H92.09","Z83.3","Z80.8","Z83.2","Z82.49","Z83.518","M27.3","A59.01"],"date":["2019-12-17","2021-05-19","2019-05-18","2021-12-30","2019-03-05","2021-12-30","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2021-05-19","2020-11-29","2021-10-24","2021-12-30","2019-05-20","2019-07-21","2019-07-21","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2019-12-16","2021-09-11","2020-03-25","2021-05-19","2021-05-19","2021-11-10","2021-11-18","2019-12-17","2019-12-17","2020-03-02","2020-02-10","2020-08-29","2021-03-08","2021-10-24","2019-06-04","2019-01-03","2020-01-07","2020-01-08","2019-05-20","2020-10-01","2020-10-01","2020-10-01","2020-12-15","2020-12-28","2019-02-01","2019-07-21","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-03-02"],"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":[["","","METHYLPRED"," METHYLPRED ","21","Select","Select",""],["","","METHOCARBAM"," METHOCARBAM ","30","Select","Select",""],["","","LIDOCAINE"," LIDOCAINE ","30","Select","Select",""],["","","ADDERALL"," ADDERALL ","30","Select","Select",""],["","","VALACYCLOVIR"," VALACYCLOVIR ","4","Select","Select",""],["","","LAMOTRIGINE"," LAMOTRIGINE ","60","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","20","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","LORAZEPAM"," LORAZEPAM ","30","Select","Select",""],["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","30","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","15","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","ALLERGY\/CONG","TAB 5-120MG","","Select","Select",""],["","","CLARITIN-D","TAB 5-120MG","","Select","Select",""],["","","PREDNISONE","PAK 10MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","SALINE","SPR 0.0065","","Select","Select",""],["","","MOMETASONE","SPR 50MCG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","","ETODOLAC","TAB 400MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","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":""}]}]}