{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   L HALL","gend":0,"add":"4536 BLACKCOVE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1952-04-01","age":"","mstatus":"","insh":"900034551*01","cliId":"9CH2P15DD87","pno":"757\/464-2317","cno":"757\/464-2317","email":"","ename":"","eno":"","pphy":"WOODARD, ROBERT M MD","ppno":"757\/481-2333","pcpadd":"1120 FIRST COLONIAL RD STE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":210216,"pcpname":"Privia - First Colonial Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"757\/418-2248","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/481-1037","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.21","I42.9","M54.5","R22.40","E78.5","R07.89","J90.","I82.5Z2","J18.9","D68.52","M10.9","M79.606","M25.562","Z86.711","R06.00","R91.8","J30.1","Z86.718","I35.1","E66.09","Z68.36","N40.0","C61.","I82.409","Z23.","R91.1","I50.20","S99.922A","N40.1","N13.8","Z12.11","M19.90","I10.","Z79.01","I26.92","M25.551","M70.61","I26.99","Z13.79","I51.7","N39.0","K21.9","R06.09","R07.9","J98.11","R59.0","I50.22","J44.9","J45.30","Z20.822"],"date":["2020-01-03","2020-01-03","2020-02-27","2020-06-23","2020-12-10","2021-09-03","2021-10-11","2020-06-24","2020-07-31","2021-02-15","2021-02-23","2020-02-14","2021-03-23","2021-08-11","2021-05-07","2021-10-11","2021-08-11","2021-05-07","2021-08-11","2021-05-07","2021-05-07","2020-12-10","2021-09-01","2020-09-17","2020-09-17","2021-10-11","2020-12-10","2021-02-23","2021-09-01","2021-09-01","2021-05-23","2020-07-31","2021-08-25","2021-08-25","2020-12-24","2020-09-01","2020-09-01","2021-02-01","2021-02-03","2021-10-11","2020-02-14","2020-12-10","2021-08-14","2020-06-24","2021-10-11","2021-04-14","2021-08-25","2021-08-11","2021-08-11","2021-09-15"],"priorHcc":["","","","","",null,null,"","","","","","","","",null,"","","","","","",null,"","",null,"","",null,null,"","","","","","","","","",null,"","","","",null,"","","","",null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","65862014205","CARVEDILOL ","3.125MG","-60","Select","Select",""],["","68462024920","RANITIDINE ","300MG","-90","Select","Select",""],["","00378108601","COLCHICINE ","0.6MG","30","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","-14","Select","Select",""],["","47335095688","ALFUZOSIN ","10MG ER","-90","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","90","Select","Select",""],["","33342006207","VALSARTAN ","40MG","-90","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","15","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","-90","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","-3","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","00527133701","BACLOFEN ","20MG","30","Select","Select",""],["","00378875006","DICLOFENAC ","1%","-100","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","51224002230","AZITHROMYCIN ","250MG","4","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","16729013401","ALLOPURINOL ","100MG","30","Select","Select",""],["","00591544210","PREDNISONE ","10MG","18","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","65862014205","CARVEDILOL","3.125MG","60","Select","Select",""],["","00003089421","ELIQUIS","5MG","-60","Select","Select",""],["","00378108601","COLCHICINE","0.6MG","-30","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","53746051105","SPIRONOLACT","25MG","15","Select","Select",""],["","68462024920","RANITIDINE","300MG","-90","Select","Select",""],["","47335095688","ALFUZOSIN","10MG ER","-90","Select","Select",""],["","33342006207","VALSARTAN","40MG","90","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","-90","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","67877021620","CEFUROXIME","500MG","3","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","51224002230","AZITHROMYCIN","250MG","4","Select","Select",""],["","29300012510","MELOXICAM","15MG","-30","Select","Select",""],["","00527133701","BACLOFEN","20MG","30","Select","Select",""],["","16729013401","ALLOPURINOL","100MG","30","Select","Select",""],["","00591544210","PREDNISONE","10MG","18","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","90","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","31722052530","FINASTERIDE","5MG","90","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","65862053820","LEVOFLOXACIN","750MG","1","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","49281012165","FLUZONE","2021-22","1","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","1","Select","Select",""],["","31722052530","FINASTERIDE ","TAB 5MG","-90","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","1","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}