{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA   K NICHOLSON","gend":1,"add":"4011 ROEBLING LN","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1949-12-30","age":"","mstatus":"","insh":"900037036*01","cliId":"3N79VK8NE38","pno":"757\/647-0870","cno":"757\/647-0870","email":"","ename":"","eno":"","pphy":"JONES, THOMAS M MD","ppno":"757\/463-5240","pcpadd":"1100 FIRST COLONIAL ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":771820,"pcpname":"Privia - First Colonial Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"000\/000-0000","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R19.5","Z12.11","Z12.31","I10.","E78.5","R19.7","Z00.00","F33.0","M81.0","N95.9","Z82.62","Z87.310"],"date":["2020-04-03","2021-05-23","2021-09-09","2020-11-16","2021-08-16","2020-05-08","2020-11-16","2020-11-16","2021-08-16","2021-07-07","2021-07-07","2021-07-07"],"priorHcc":["","",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":[["","00093585001","ESCITALOPRAM ","5MG","90","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","20-12.5","180","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0","Select","Select",""],["","69097084705","","5MG","90","Select","Select",""],["","69097084705","ESCITALOPRAM","5MG","90","Select","Select",""],["","68180051902","LISINOP\/HCTZ","20-12.5","180","Select","Select",""],["","68180098103","LISINOPRIL","20MG","-90","Select","Select",""],["","70461012003","FLUAD","0.5ML","0","Select","Select",""],["","49281012165","FLUZONE","2021-22","1","Select","Select",""],["","61314012605","KETOROLAC ","SOL 0.005","-5","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","1","Select","Select",""],["","00378543035","MOXIFLOXACIN ","SOL HCL 0.5%","3","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","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":""}]}]}