{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   SEMAJNOSNEH C","gend":0,"add":" NREHTRON 293401 XOB OP RD","city":"BRODNAX","state":"VA","zip":"23920-9998","dob":"2003-07-26","age":"","mstatus":"","insh":"8398810*54","cliId":"","pno":"36\/4347944-6","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":["R50.9","J02.0","Z20.822","S06.0X9A","Y09.","R10.9","K21.9","Z03.818","Z68.32","E66.9","H10.9","H00.014","Z00.129","L30.9","B35.3","Z88.7","K12.0","S93.402A","V86.55XA","S62.511A","W21.11XA","F32.9","S49.91XA","M25.511","M54.2","R07.81","W18.30XA","U07.1","K05.10","H10.45","H50.52","H52.223","R42.","G56.03","Z76.89","J03.00","R11.2","J02.8","M79.644","S62.501A","K52.9","J02.9","J40.","J06.9","V62.84","S62.509A","H66.93","J03.90","J20.9"],"date":["2021-11-01","2021-10-29","2021-10-29","2019-08-03","2019-08-03","2020-06-05","2020-07-07","2020-06-05","2020-06-05","2020-06-05","2021-07-12","2021-07-12","2020-07-07","2019-03-28","2021-03-24","2020-07-07","2020-01-30","2019-06-28","2019-06-28","2019-09-25","2019-09-25","2021-03-24","2019-02-08","2019-02-08","2019-02-08","2019-02-08","2019-02-08","2021-11-08","2020-01-30","2020-10-16","2020-10-16","2020-10-16","2021-03-24","2021-03-24","2021-11-01","2021-11-01","2021-11-01","2021-06-23","2019-09-23","2019-09-23","2020-06-02","2020-11-08","2020-11-08","2020-11-08","2021-03-15","2019-09-25","2020-11-05","2020-11-05","2020-11-05"],"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":[["","","TRIAMCINOLON"," TRIAMCINOLON ","80","Select","Select",""],["","","ACYCLOVIR"," ACYCLOVIR ","40","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","20","Select","Select",""],["","","KETOROLAC"," KETOROLAC ","12","Select","Select",""],["","","SMZ-TMP","TAB 400-80MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG DR","","Select","Select",""],["","","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","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":""}]}]}