{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ATINROCNOSREDNA D","gend":1,"add":"NALREBMIT 553202 TPA NL D","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1989-02-08","age":"","mstatus":"","insh":"13200210*23","cliId":"","pno":"78\/0455355-2","cno":"540\/429-6157","email":"","ename":"","eno":"","pphy":"DONOVAN, DEIRDRE E MD","ppno":"434\/817-1818","pcpadd":"STE 9 310 AVON STREET","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":"","pcpname":"Privia - Downtown Family Health Care, Inc","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F25.0","R35.0","Z86.39","H57.13","H43.392","T15.01XA","T15.02XA","S61.011A","G47.10","R06.83","G47.00","R40.0","E66.9","Z68.30","E11.9","F32.9","K21.9","Z79.899","F17.210","K29.60","R13.10","G47.33","G47.01","F41.1","R06.02","J39.2","D36.9","N30.00","R39.9","L70.0","Z00.00","N92.6","G47.20","F17.200","J38.5","F45.8","R10.13","A63.0","Z11.3","Z01.419","N90.89","R06.89","F80.81","R53.83","G47.9","M54.5","G89.29","R13.11","R09.81","R05.","K31.89"],"date":["2021-12-17","2020-05-04","2020-05-04","2020-02-14","2020-08-28","2021-09-02","2021-09-02","2021-07-23","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-11-11","2019-07-05","2019-07-05","2019-08-30","2019-08-30","2019-05-22","2019-05-22","2019-09-04","2019-09-04","2019-11-11","2019-03-06","2019-05-01","2019-05-01","2019-05-01","2019-05-28","2019-05-28","2019-05-28","2019-09-25","2019-07-23","2019-10-30","2019-10-16","2019-02-18","2019-02-18","2019-02-18","2019-02-27","2019-03-20","2019-03-20","2019-07-30","2019-07-30","2019-06-04","2019-06-04","2019-03-28","2019-09-25","2019-09-25","2019-10-30"],"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":[["","00093777201","CLOZAPINE","TAB 100MG","30","Select","Select",""],["","00378130005","LITHIUM","TAB 300MG ER","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","","JUNEL","TAB 43831","","Select","Select",""],["","00591289030","NICOTINE","DIS 7MG\/24HR","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00536109808","MELATONIN","TAB 5MG","30","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","23155050101","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","67877057301","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","15","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","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":""}]}]}