{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LREBMIKSESOM Y","gend":1,"add":"NOTLRAC 005195 TOL EVA ","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1979-08-30","age":"","mstatus":"","insh":"2281110*29","cliId":"","pno":"64\/4340104-5","cno":"434\/295-6222","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":"M4","region":"CHARLOTTESVILLE WESTERN","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":["Z23.","G47.33","Z09.","R07.9","F41.9","Z72.0","B36.9","L91.8","J45.30","K21.9","L30.9","R73.03","E66.01","Z68.43","S30.1XXA","J02.9","NO DATA","Z87.891","L21.9","Z68.42","E53.8","E55.9","Z01.419","E78.1","F51.04","M79.672","M72.2","J45.909","D53.1","R09.81","R05.","R10.9","J01.10","R06.2","F17.200","S16.1XXA","R06.09","Z68.41","E66.9","R06.83","S50.11XA","D25.0","N93.9","N92.1","D50.0","D21.9","Z30.432","D25.9","J44.1","J45.21","D50.9","J20.9","U07.1","R07.89","J22.","Z28.310","Z20.822","D25.1","J98.8","J39.2","F17.210","Z88.8","M76.62","Z01.818"],"date":["2020-11-10","2022-10-10","2020-01-21","2022-05-12","2021-04-28","2020-01-28","2020-06-19","2020-07-14","2020-12-30","2021-04-28","2020-12-30","2021-04-28","2022-05-13","2021-04-28","2020-01-28","2021-02-09","2020-01-16","2020-01-16","2020-06-15","2020-08-04","2021-04-28","2021-04-28","2020-08-04","2021-04-28","2020-08-04","2022-01-26","2022-09-28","2021-04-28","2021-04-28","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-05-06","2019-05-06","2022-05-12","2022-05-12","2019-02-06","2022-01-02","2022-11-10","2022-04-25","2022-11-10","2022-08-31","2022-08-31","2022-03-10","2022-10-25","2022-05-16","2022-05-13","2022-05-13","2022-08-06","2022-08-06","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-06-08","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-09-28","2022-10-25"],"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":[["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","59762005601","MEDROXYPR","TAB 10MG","68","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","90","Select","Select",""],["","69367027216","CODEINE\/GG","SOL 10-100\/5","50","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","32","Select","Select",""],["","00074364103","LUPRON","INJ 3.75MG","1","Select","Select",""],["","00085461001","DULERA","AER 200-5MCG","13","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","60","Select","Select",""],["","","LORATADINE"," LORATADINE ","30","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","","FOLIC","TAB 400MCG","","Select","Select",""],["","","FENOFIBRATE"," FENOFIBRATE ","30","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00781107905","ALPRAZOLAM","TAB 1MG","1","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","10135012310","ACETAMIN","TAB 325MG","60","Select","Select",""],["","00536132701","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","METFORMIN","TAB 500MG ER","","Select","Select",""],["","59779061275","ALLERGY","TAB 10MG","90","Select","Select",""],["","","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","00168020230","CLINDAMYCIN","GEL 0.01","30","Select","Select",""],["","","B-12","TAB 2000MCG","","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","00093415580","AMOXICILLIN","SUS 250\/5ML","150","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","","NYSTATIN","POW 100000","","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","180","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","AQUAPHOR","OIN ","","Select","Select",""],["","","ESOMEPRA","CAP 40MG DR","","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","41100080247","CLARITIN","TAB 10MG","90","Select","Select",""],["","","CERAVE","CRE RELIEF","","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":""}]}]}